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All Studies   Meta Analysis    Recent:   
0 0.5 1 1.5 2+ Mortality 20% Improvement Relative Risk Improvement 35% Remdesivir  Garibaldi et al.  LATE TREATMENT Is late treatment with remdesivir beneficial for COVID-19? Retrospective 606 patients in the USA Greater improvement with remdesivir (p=0.000015) Garibaldi et al., medRxiv, November 2020 Favors remdesivir Favors control

Effectiveness of remdesivir with and without dexamethasone in hospitalized patients with COVID-19

Garibaldi et al., medRxiv, doi:10.1101/2020.11.19.20234153
Nov 2020  
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Retrospective 303 remdesivir patients and 303 matched controls showing significantly faster clinical improvement, and lower (but not statistically significant) mortality.
Gérard, Wu, Zhou show significantly increased risk of acute kidney injury with remdesivir.
risk of death, 20.0% lower, HR 0.80, p = 0.44, treatment 23 of 303 (7.6%), control 45 of 303 (14.9%), adjusted per study, day 28.
risk of no improvement, 35.0% better, RR 0.65, p < 0.001, treatment 52 of 303 (17.2%), control 80 of 303 (26.4%), NNT 11, adjusted per study, day 28.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Garibaldi et al., 20 Nov 2020, retrospective, USA, preprint, 10 authors.
This PaperRemdesivirAll
Effectiveness of remdesivir with and without dexamethasone in hospitalized patients with COVID-19
MD MEHP Brian T Garibaldi, MS Kunbo Wang, MD Matthew L Robinson, PhD Scott L Zeger, PhD Karen Bandeen Roche, PhD Mei-Cheng Wang, MD G Caleb Alexander, MD Amita Gupta, MD MPH Robert Bollinger, PhD Yanxun Xu
Rationale: Remdesivir and dexamethasone reduced the severity of COVID-19 in clinical trials. However, their individual or combined effectiveness in clinical practice remains unknown. Objectives: To examine the effectiveness of remdesivir with or without dexamethasone. Methods: We conducted a multicenter, retrospective cohort study between March 4 and August 29, 2020. Eligible COVID cases were hospitalized patients treated with remdesivir with or without dexamethasone. We applied a Cox proportional hazards model with propensity score matching to estimate the effect of these treatments on clinical improvement by 28 days (discharge or a 2-point decrease in WHO severity score) and 28-day mortality. Measurements and Main Results: Of 2485 COVID-19 patients admitted between March 4 and August 29, 2020, 342 received remdesivir and 157 received remdesivir plus dexamethasone. Median age was 60 years; 45% were female; 81% were non-white. Remdesivir recipients on room air or nasal cannula oxygen had a faster time to clinical improvement (median 5.0 days [IQR 4.0, 8.0], remdesivir vs. 7.0 days [IQR 5.0, 12.0], control; adjusted hazard ratio (aHR) 1.55 [1.28; 1.87]), yet those requiring higher levels of respiratory support did not benefit. Remdesivir recipients had lower, but statistically insignificant, 28-day mortality (7.6% [23 deaths], remdesivir vs. 14.9% [45 deaths], control). Adding dexamethasone trended toward lower 28-day mortality compared to remdesivir alone (5.1% [8 deaths] vs. 9.2% [17 deaths]; aHR 0.14 [0.02; 1.03]). Conclusions: Remdesivir offered a significantly faster time to clinical improvement among a cohort of predominantly non-white patients hospitalized with COVID-19, particularly with mildmoderate disease. Remdesivir plus dexamethasone may reduce mortality.
Beigel, Tomashek, Dodd, Remdesivir for the Treatment of Covid-19 -Preliminary Report, New Engl J Med
Chastain, Osae, Henao-Martínez, Franco-Paredes, Chastain et al., Racial Disproportionality in Covid Clinical Trials, New Engl J Med
Davis, Mccreary, Pogue, That Escalated Quickly: Remdesivir's Place in Therapy for COVID-19, Infect Dis Ther
Garibaldi, Fiksel, Muschelli, Patient trajectories and risk factors for severe outcomes among persons hospitalized for COVID-19 in the Maryland/DC region, medRxiv
Goldman, Lye, Hui, Remdesivir for 5 or 10 Days in Patients with Severe Covid-19, N Engl J Med
Hernán, Brumback, Robins, Marginal structural models to estimate the causal effect of zidovudine on the survival of HIV-positive men, Epidemiology
Horby, Lim, Emberson, Dexamethasone in Hospitalized Patients with Covid-19 -Preliminary Report, N Engl J Med
Ison, Wolfe, Boucher, Emergency Use Authorization of Remdesivir: The Need for a Transparent Distribution Process, JAMA
Jorgensen, Kebriaei, Dresser, Remdesivir: Review of Pharmacology, Preclinical Data, and Emerging Clinical Experience for COVID-19, Pharmacotherapy
Kabpw, Remdesivir Could Be in Short Supply. Here's a Fix, The New York Times
Lu, Propensity score matching with time-dependent covariates, Biometrics
Mulangu, Dodd, Davey, A Randomized, Controlled Trial of Ebola Virus Disease Therapeutics, N Engl J Med
Shah, Sachdeva, Dodiuk-Gad, COVID-19 and racial disparities, Journal of the American Academy of Dermatology
Spinner, Gottlieb, Criner, Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19: A Randomized Clinical Trial, JAMA
Tchesnokov, Feng, Porter, Götte, Mechanism of Inhibition of Ebola Virus RNA-Dependent RNA Polymerase by Remdesivir, Viruses
Wang, Cao, Zhang, Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro, Cell Res
Wang, Zhang, Du, Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial, Lancet
Williamson, Feldmann, Schwarz, Clinical benefit of remdesivir in rhesus macaques infected with SARS-CoV-2, Nature
Xie, Bowe, Li, Xian, Yan et al., Risk of death among users of Proton Pump Inhibitors: a longitudinal observational cohort study of United States veterans, BMJ Open
Late treatment
is less effective
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