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Remdesivir for the treatment of patients in hospital with COVID-19 in Canada: a randomized controlled trial

Ali et al., Canadian Medical Association Journal, doi:10.1503/cmaj.211698, CATCO, NCT04330690
Jan 2022  
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Mortality, day 60 12% Improvement Relative Risk Mortality 17% Mortality, day 15 21% Ventilation 47% Recovery 9% Hospitalization time -11% Remdesivir  CATCO  LATE TREATMENT  RCT Is late treatment with remdesivir beneficial for COVID-19? RCT 1,281 patients in Canada Lower ventilation (p=0.00028) and longer hospitalization (p=0.036) Ali et al., Canadian Medical Associati.., Jan 2022 Favorsremdesivir Favorscontrol 0 0.5 1 1.5 2+
RCT 1,282 hospitalized patients in Canada showing lower mechanical ventilation with remdesivir treatment, but no significant difference for mortality.
Gérard, Zhou, Wu, Kamo, Choi show significantly increased risk of acute kidney injury with remdesivir.
risk of death, 12.0% lower, RR 0.88, p = 0.21, treatment 127 of 634 (20.0%), control 152 of 647 (23.5%), NNT 29, day 60.
risk of death, 17.0% lower, RR 0.83, p = 0.09, treatment 117 of 634 (18.5%), control 145 of 647 (22.4%), NNT 25, in hospital.
risk of death, 20.6% lower, RR 0.79, p = 0.59, treatment 14 of 634 (2.2%), control 18 of 647 (2.8%), NNT 174, day 15.
risk of mechanical ventilation, 47.0% lower, RR 0.53, p < 0.001, treatment 46 of 634 (7.3%), control 89 of 647 (13.8%), NNT 15, day 60.
risk of no recovery, 9.0% lower, RR 0.91, p = 0.41, treatment 634, control 647, clinical status, day 60.
hospitalization time, 11.1% higher, relative time 1.11, p = 0.04, treatment median 10.0 IQR 12.0 n=634, control median 9.0 IQR 11.0 n=647.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Ali et al., 19 Jan 2022, Randomized Controlled Trial, Canada, peer-reviewed, 85 authors, average treatment delay 8.0 days, trial NCT04330690 (history) (CATCO).
This PaperRemdesivirAll
Remdesivir for the treatment of patients in hospital with COVID-19 in Canada: a randomized controlled trial
Karim Ali, Tanweer Azher, Mahin Baqi, Alexandra Binnie, Sergio Borgia, François M Carrier, Yiorgos Alexandroa Cavayas, Nicolas Chagnon, Matthew P Cheng, John Conly, Cecilia Costiniuk, Peter Daley, Nick Daneman, Josh Douglas, Catarina Downey, Erick Duan, Emmanuelle Duceppe, Madeleine Durand, Shane English, George Farjou, Evradiki Fera, Patricia Fontela, Rob Fowler, Michael Fralick, Anna Geagea, Jennifer Grant, Luke B Harrison, Thomas Havey, Holly Hoang, Lauren E Kelly, Yoav Keynan, Kosar Khwaja, Gail Klein, Marina Klein, Christophe Kolan, Nadine Kronfli, Francois Lamontagne, Rob Lau, Michael Fralick, Todd C Lee, Nelson Lee, Rachel Lim, Sarah Longo, Alexandra Lostun, Erika Macintyre, Isabelle Malhamé, Kathryn Mangof, Marlee Mcguinty, Sonya Mergler, Matthew P Munan, Srinivas Murthy, Conar O’neil, Daniel Ovakim, Jesse Papenburg, Ken Parhar, Seema Nair Parvathy, Chandni Patel, Santiago Perez-Patrigeon, Ruxandra Pinto, Subitha Rajakumaran, Asgar Rishu, Malaika Roba-Oshin, Moira Rushton, Mariam Saleem, Marina Salvadori, Kim Scherr, Kevin Schwartz, Makeda Semret, Michael Silverman, Ameeta Singh, Wendy Sligl, Stephanie Smith, Ranjani Somayaji, Darrell H S Tan, Siobhan Tobin, Meaghan Todd, Tuong-Vi Tran, Alain Tremblay, Jennifer Tsang, Alexis Turgeon, Erik Vakil, Jason Weatherald, Cedric Yansouni, Ryan Zarychanski
Canadian Medical Association Journal, doi:10.1503/cmaj.211698
T he role of remdesivir in treating patients in hospital with COVID-19 remains ill defined. 1 Remdesivir, a repurposed antiviral medication, has full or emergency approval from a number of regulators -including Health Canada -for the treatment of COVID-19, based on clinical trial data documenting a benefit on improving time to recovery. 2 An interim report of the larger World Health Organization (WHO) Solidarity trial showed no difference regarding mortality or need for mechanical ventilation, with a number of smaller trials being inconclusive on these important outcomes. [3] [4] [5] [6] Recommendations of clinical guidelines are mixed, with some recommending remdesivir as standard of care, and others weakly recommending against. 7, 8 Its impact on other clinical outcomes, including resource utilization and post-hospital stay outcomes, has not been fully defined, and there remains a possibility of an important treatment effect, particularly in certain groups of patients. 9 Research Remdesivir for the treatment of patients in hospital with COVID-19 in Canada: a randomized controlled trial Canadian Treatments for COVID-19 (CATCO)*; for the Association of Medical Microbiology and Infectious Disease Canada (AMMI) Clinical Research Network and the Canadian Critical Care Trials Group
Authors: Karim Ali, Tanweer Azher, Mahin Baqi, Alexandra Binnie, Competing interests: Alexandra Binnie reports receiving research grants from the Canadian Institutes of Health Research (CIHR) and the Physicians Services Incorporated Foundation. Sergio Borgia reports receiving honoraria from Gilead Sciences and GSK. Yiorgos Alexandros Cavayas reports receiving a grant from CIHR. Matthew Cheng reports receiving grants from the McGill Interdisciplinary Initiative in Infection and Immunity and from CIHR, during the conduct of the study (payments made to the institution). Dr. Cheng also reports receiving personal fees from AstraZeneca, outside the submitted work; and from Nplex Biosciences and GEn1E lifesciences (in the form of stock options for being a member of the scientific advisory board) outside the submitted work. Dr. Cheng co-founded Kanvas Biosicences and owns equity in the company, and reports 3 patents pending. Ameeta Singh reports receiving consulting fees from Gilead for membership of an advisory board. Ranjani Somayaji reports receiving contract research funding from Sunnybrook Research Institute, University of Calgary and Calgary Health Foundation, and clinical research funding from CIHR and the Cystic Fibrosis Foundation. Dr. Somayaji also reports participation on an oncovir data monitoring safety board. Darrell Tan reports receiving grants from AbbVie (in-kind drug only) and Gilead (inkind drug and grants to institution), and a contract between GSK and the..
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Late treatment
is less effective
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