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0 0.5 1 1.5 2+ Hospitalization time 9% Improvement Relative Risk Hospitalization time (b) 22% Viral clearance 0% Remdesivir  Goldberg et al.  LATE TREATMENT Is late treatment with remdesivir beneficial for COVID-19? Retrospective 142 patients in Israel No significant difference in outcomes seen c19early.org Goldberg et al., Clinical Microbiology.., Mar 2021 Favors remdesivir Favors control

A real-life setting evaluation of the effect of remdesivir on viral load in COVID-19 patients admitted to a large tertiary center in Israel

Goldberg et al., Clinical Microbiology and Infection, doi:10.1016/j.cmi.2021.02.029
Mar 2021  
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Retrospective 29 remdesivir patients and 113 controls, not finding a significant difference in nasopharyngeal viral load or hospitalization time. Hospitalization time was lower with treatment, with a larger reduction for non-intubated patients, although not statistically significant in both cases.
Gérard, Wu, Zhou show significantly increased risk of acute kidney injury with remdesivir.
hospitalization time, 9.2% lower, relative time 0.91, p = 0.77, treatment 29, control 113.
hospitalization time, 21.8% lower, relative time 0.78, p = 0.30, non-intubated patients only.
risk of no viral clearance, 0.1% lower, RR 1.00, p = 0.98, treatment 29, control 113, relative change in Ct values.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Goldberg et al., 9 Mar 2021, retrospective, Israel, peer-reviewed, 7 authors.
This PaperRemdesivirAll
A real-life setting evaluation of the effect of remdesivir on viral load in COVID-19 patients admitted to a large tertiary centre in Israel
Elad Goldberg, Haim Ben Zvi, Liron Sheena, Summer Sofer, Ilan Krause, Ella H Sklan, Amir Shlomai
Clinical Microbiology and Infection, doi:10.1016/j.cmi.2021.02.029
Objectives: The effectiveness of remdesivir, a Food and Drug Administration-approved drug for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has been repeatedly questioned during the current coronavirus disease 2019 (COVID-19) pandemic. Most of the recently reported studies were randomized controlled multicentre clinical trials. Our goal was to test the efficiency of remdesivir in reducing nasopharyngeal viral load and hospitalization length in a real-life setting in patients admitted to a large tertiary centre in Israel. Methods: A total of 142 COVID-19 patients found to have at least three reported SARS-CoV-2 quantitative RT-PCR tests during hospitalization were selected for this study. Of these, 29 patients received remdesivir, while the remaining non-treated 113 patients served as controls. Results: Among the tested parameters, the control and remdesivir groups differed significantly only in the intubation rates. Remdesivir treatment did not significantly affect nasopharyngeal viral load, as determined by comparing the differences between the first and last cycle threshold values of the SARS-CoV-2 quantitative RT-PCR tests performed during hospitalization (cycle threshold 7.07 ± 6.85 vs. 7.08 ± 7.27, p 0.977 in the control and treated groups, respectively). Remdesivir treatment shortened hospitalization length by less than a day compared with non-treated controls and by 3.1 days when nonintubated patients from both groups were compared. These differences, however, were not statistically significant, possibly because of the small size of the remdesivir group. Discussion: Remdesivir was not associated with nasopharyngeal viral load changes, but our study had a significant disease severity baseline imbalance and was not powered to detect viral load or clinical differences.
Transparency declaration The authors declare that they have no conflicts of interest. Author contributions E.G. and E.H.S. conceptualized the study and its methodology. H.B.Z., L.S. and S.S. collected and analysed the data. I.K., A.S., E.G., and E.H.S. wrote the first draft. All authors reviewed and edited the final manuscript. Appendix A. Supplementary data Supplementary data to this article can be found online at https://doi.org/10.1016/j.cmi.2021.02.029.
References
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Shlomai, Ben-Zvi, Bendersky, Shafran, Goldberg et al., Nasopharyngeal viral load predicts hypoxemia and disease outcome in admitted COVID-19 patients, Crit Care
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Late treatment
is less effective
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