Download Image
    
Share
  
Post
c19early.org
Remdesivir for COVID-19
81 studies with >200,000 patients
Serious outcome risk
Remdesivir
Control
No significant improvement in meta-analysis.
Mortality worse with longer follow-up—antiviral efficacy may be offset by side effects.
Studies show significantly increased risk of acute kidney injury, liver injury, and cardiac disorders.
COVID-19 Remdesivir studies · October 2026
Remdesivir is a nucleoside analog that affects RNA replication. Off-target effects include mitochondrial1-5 and organ toxicity. Studies show significantly increased risk of acute kidney injury6-11, liver injury12-16, and cardiac disorders1,17-20. Harms may be greater than suggested from short-term follow-up, with significant long-term morbidity. Variants may be less susceptible to remdesivir21-23. Remdesivir was adopted in 72 countries. Recent:
Tawfik
Khatun
Lew
Akinci.
Covid Analysis Remdesivir for COVID-19: real-time meta-analysis of 81 studies (Version 109)
Meta-analysis using the most serious outcome reported shows 4% [-4‑13%] higher risk, without reaching statistical significance. Meta regression with follow-up duration shows that mortality results are worse with longer follow-u..
Jun 24
 Lew et al., Cells, doi:10.3390/cells15131146 Combination of Remdesivir and Ivermectin Exerts Highly Potent and Synergistic Antiviral Activity Against Murine Coronavirus and SARS-CoV-2 Infections
In vitro study showing synergistic antiviral activity of ivermectin and remdesivir against murine coronavirus (MHV) and SARS-CoV-2.
Jun 17
 Khatun et al., Elsevier BV, doi:10.2139/ssrn.6942990 An All-Oral Antiviral Combination Strategy against COVID-19 Enabled by the Synergistic Mechanism of Action of Auranofin and Remdesivir
Preclinical study (in vitro and mouse model) demonstrating synergistic antiviral efficacy of auranofin and GS-621763 (an oral prodrug of remdesivir) against SARS-CoV-2.
May 1
 Tawfik et al., American Journal of Respiratory and Critical Care Medicine, doi:10.1093/ajrccm/aamag162.5165 When Treatment Turns Toxic: Acute Liver Failure Following Remdesivir Therapy
Case report of a 90-year-old hospitalized patient showing acute liver failure following remdesivir treatment. The patient developed acute liver failure within 24 hours of receiving one dose of remdesivir, with AST >7000 U/L, ALT 4446 U/L,..
Apr 2
 Zhu et al., Pharmaceuticals, doi:10.3390/ph19040574 Cardiovascular Risks of COVID-19 Therapeutics: Integrated Analysis of FAERS, Electronic Health Records, and Transcriptomics
Pharmacovigilance and EHR analysis of 8,143 FAERS remdesivir reports and over 255,000 TriNetX EHR records, showing significantly higher risk of cardiovascular adverse events (bradycardia, hypotension, and cardiac arrest) with remdesivir c..
Mar 6
 Nicholson et al., Am. J. Health-Syst. Pharm., doi:10.1093/ajhp/zxaf258 Impact of Implementing More Restrictive Remdesivir Criteria Across a Multi-Hospital Health System
Retrospective 2,249 hospitalized COVID-19 patients showing lower mortality after restricting remdesivir use. Mortality reduced from 7.6% to 5.6% (p = 0.12) after restriction. No baseline details are provided and results are subject to con..
Feb 28
 Mihai et al., International Journal of Molecular Sciences, doi:10.3390/ijms27052288 Circulating Liver-Enriched miR-122 in COVID-19 Patients: A Longitudinal Real-Life Study
Prospective cohort study of 78 COVID-19 patients and 18 non-COVID-19 participants in Romania, reporting that prior therapeutic paracetamol use before hospital presentation was independently associated with higher miR-122 (a liver-specific..
Feb 12
 Bagheri et al., PLOS One, doi:10.1371/journal.pone.0336221 Remdesivir may exacerbate ischemic acute kidney injury through molecular alterations in PGC-1α and apoptosis pathways: An in vivo study
Animal study (rat model) showing potential harm of remdesivir in ischemia/reperfusion-induced acute kidney injury. Authors found that subcutaneous RDV significantly decreased PGC-1α expression - a master regulator of mitochondrial biogene..
Jan 31
 Li et al., Molecules, doi:10.3390/molecules31030498 Drug–Target Interaction Prediction via Dual-Interaction Fusion
In silico study showing that the GADFDTI computational model successfully predicts drug-target interactions for SARS-CoV-2 proteins, achieving high prediction accuracy with AUC values of 0.986 and 0.996 on benchmark datasets. The model as..
Jan 7
 Heiran et al., BMC Cardiovascular Disorders, doi:10.1186/s12872-025-05376-2 High incidence of post-discharge cardiovascular mortality after COVID-19 hospitalization: a data-linkage study in Southern Iran
22% higher mortality (p=0.2). Retrospective 845 COVID-19 patients who died from cardiovascular causes after hospital discharge. In multivariable analysis, remdesivir treatment showed a non-significant trend toward increased hazard of death (aHR: 1.217, 95% CI: 0.891-1..
Dec 31
2025
 Tong et al., NCT04483960 A Multi-centre Randomised Adaptive Platform Clinical Trial to Assess Clinical, Virological and Immunological Outcomes in Patients With SARS-CoV-2 Infection (COVID-19)
Estimated 2,200 patient remdesivir late treatment RCT with results not reported over 9 months after estimated completion.
Dec 1
2025
 Floridia et al., Le Infezioni in Medicina, doi:10.53854/liim-3304-4 Administration of antivirals, IL-6 inhibitors, monoclonal neutralizing antibodies and systemic corticosteroids in acute SARS-CoV-2 infection do not reduce the subsequent burden of Long-COVID symptoms
23% higher long COVID (p=0.37). Retrospective 1,534 patients (67% hospitalized) accessing long-COVID centers in Italy showing higher persistent long-COVID symptoms with antiviral treatment (97% remdesivir) after adjustment for confounders, without statistical significan..
Nov 20
2025
 Ali et al., Journal of Medical Virology, doi:10.1002/jmv.70713 Preclinical Screening Platform Identifies Azatadine‐Dimaleate as a Potent Repurposed Therapeutic Against SARS‐CoV‐2 Infection
In vitro, ex vivo, and mouse study showing potent antiviral activity of azatadine-dimaleate, a H1-receptor antagonist, against SARS-CoV-2. Combination with remdesivir demonstrated strong synergy.
Oct 7
2025
 Kim et al., Virulence, doi:10.1080/21505594.2025.2568052 Reduction of extracellular vimentin in blood provides protection against SARS-CoV-2 infection
Animal study showing that the anti-eVIM monoclonal antibody hzVSF-v13 provides protection against SARS-CoV-2 infection in Roborovski SH101 hamsters. Authors found that intravenous injection of hzVSF-v13 dramatically improved disease manif..
Oct 3
2025
 Mohammed et al., Medicine, doi:10.1097/MD.0000000000044501 Bradycardia associated with remdesivir treatment in coronavirus disease 2019 patients: A propensity score-matched analysis
117% longer hospitalization (p<0.0001) and 58% worse results (p=0.01). Retrospective 645 hospitalized COVID-19 patients in the USA showing higher incidence of bradycardia and longer hospital stay with remdesivir treatment. Mortality was lower, however the reported p-value of <0.001 is not plausible. With 1 d..
Sep 11
2025
 Cheng et al., Infectious Diseases and Therapy, doi:10.1007/s40121-025-01225-z Cardiovascular Safety of COVID-19 Treatments: A Disproportionality Analysis of Adverse Event Reports from the WHO VigiBase
Retrospective disproportionality analysis of 276,631 COVID-19 adverse event reports from the WHO VigiBase database showing that remdesivir and baricitinib were associated with 2.4-fold and 2.3-fold increased odds of cardiovascular adverse..
Jul 29
2025
 Fernandez-Antunez et al., Viruses, doi:10.3390/v17081055 SARS-CoV-2 Remdesivir Exposure Leads to Different Evolutionary Pathways That Converge in Moderate Levels of Drug Resistance
In vitro and hamster study showing that SARS-CoV-2 can develop resistance to remdesivir through multiple evolutionary pathways.
Jun 26
2025
 Shen et al., Pharmaceutics, doi:10.3390/pharmaceutics17070832 Carboxylesterase Factors Influencing the Therapeutic Activity of Common Antiviral Medications Used for SARS-CoV-2 Infection
Review of how carboxylesterase (CES) enzymes influence the activity of certain COVID-19 antivirals, focusing on remdesivir, molnupiravir, nirmatrelvir, and favipiravir. Authors highlight that remdesivir requires activation by CES1, while ..
Jun 5
2025
 Negru et al., Biomedicines, doi:10.3390/biomedicines13061387 Comparative Pharmacovigilance Analysis of Approved and Repurposed Antivirals for COVID-19: Insights from EudraVigilance Data
Pharmacovigilance analysis of 64,776 adverse event reports from EudraVigilance comparing safety profiles of COVID-19 antivirals, showing remdesivir associated with more serious adverse events compared to paxlovid. Remdesivir showed consis..
May 1
2025
 Gupta et al., Infectious Disease Reports, doi:10.3390/idr17030043 Incidence of COVID-19 Symptom Rebound After Treatment with Remdesivir
Retrospective 155 patients with mild to moderate COVID-19 showing significantly lower symptom rebound rates with remdesivir compared with paxlovid. Authors provide an analysis of rebound with paxlovid, showing higher rates in prospective ..
Mar 18
2025
 Iriyama et al., PNAS Nexus, doi:10.1093/pnasnexus/pgaf085 Clinical and molecular landscape of prolonged SARS-CoV-2 infection with resistance to remdesivir in immunocompromised patients
Clinical and virological study of 3 immunocompromised B-cell lymphoma patients with prolonged SARS-CoV-2 infection showing development of remdesivir and sotrovimab resistance. Through serial viral genome sequencing, authors identified NSP..
Mar 13
2025
 Vukovikj et al., Eurosurveillance, doi:10.2807/1560-7917.ES.2025.30.10.2400252 Impact of SARS-CoV-2 variant mutations on susceptibility to monoclonal antibodies and antiviral drugs: a non-systematic review, April 2022 to October 2024
Review of SARS-CoV-2 variant mutations and their impact on susceptibility to monoclonal antibodies and antivirals. Mutations in the ORF1ab region led to decreased susceptibility to paxlovid, while nsp12 mutations reduced efficacy for remd..
Mar 11
2025
 Pacnejer et al., Journal of Clinical Medicine, doi:10.3390/jcm14061886 Comparative Analysis of Neuropsychiatric Adverse Reactions Associated with Remdesivir and Nirmatrelvir/Ritonavir in COVID-19 Treatment: Insights from EudraVigilance Data
Pharmacovigilance analysis of 8,078 paxlovid 3,934 remdesivir case safety reports from the EudraVigilance database, showing paxlovid associated with significantly higher incidence of neuropsychiatric adverse drug reactions. Paxlovid repor..
Feb 26
2025
 Petrov et al., Safety and Risk of Pharmacotherapy, doi:10.30895/2312-7821-2025-458 The Effect of Potentially Hepatotoxic Medicinal Products on Alanine Transaminase Levels in COVID-19 Patients: A Case–Control Study
Case-control study of 1,296 hospitalized COVID-19 patients showing remdesivir associated with significantly increased ALT levels (OR 4.38, p<0.001).
Feb 26
2025
 Angleitner et al., In Vivo, doi:10.21873/invivo.13887 Prolonged Viral Shedding of SARS-CoV-2 in Patients With Underlying Haemato-oncological Disease
223% slower viral clearance (p=0.004). Analysis of 63 hematological malignancy patients showing prolonged SARS-CoV-2 viral shedding (average 47 days) associated with immunosuppression status and with remdesivir use.
Feb 12
2025
 Saha et al., Viruses, doi:10.3390/v17020252 Inhaled Dry Powder of Antiviral Agents: A Promising Approach to Treating Respiratory Viral Pathogens
Review of inhaled dry powder antiviral formulations for treating respiratory viral infections, focusing on COVID-19. Authors explain that traditional antiviral tablets face limitations including systemic side effects and delayed onset of ..
Dec 20
2024
 Rahman, M. Elucidation of the DNA repair mechanisms involved in the repair of DNA damage caused by the Arabinosides and Anti-COVID-19 drugs
In vitro study showing potential genotoxic side effects of remdesivir and molnupiravir linked to DNA repair pathway deficiencies. Remdesivir incorporation into nascent DNA caused replication fork stalling and acute S-phase arrest in FEN1-..
Nov 27
2024
 Schuh et al., Journal of The Royal Society Interface, doi:10.1098/rsif.2024.0536 Within-host dynamics of antiviral treatment with remdesivir for SARS-CoV-2 infection
Retrospective 369 COVID-19 patients in Greece showing no significant improvement in mortality with remdesivir treatment. The study tracked 88 patients in detail, including 19 treated with remdesivir, and found that delayed hospitalization..
Nov 15
2024
 Morad, R., Elsevier BV, doi:10.2139/ssrn.5021494 Coating of Remdesivir and Ivermectin on Silver Nanoparticles: First Principle Study
In silico study showing that silver nanoparticles could be used as a therapeutic drug delivery mechanism for remdesivir and ivermectin against SARS-CoV-2. Using Density Functional Theory calculations, authors find that both drugs bond str..
Nov 12
2024
 Patrick-Brown et al., Communications Medicine, doi:10.1038/s43856-024-00650-4 The effects of remdesivir on long-term symptoms in patients hospitalised for COVID-19: a pre-specified exploratory analysis
Long-term results for the NOR-Solidarity RCT showing worse long-term outcomes at 3 months with remdesivir compared to SoC with or without HCQ. The CAT total score was 16.8 vs. 11.4, p = 0.06, close to statistical significance for harm. Se..
Nov 12
2024
 Kim et al., Pharmacoepidemiology and Drug Safety, doi:10.1002/pds.70043 Investigating the Safety Profile of Fast‐Track COVID‐19 Drugs Using the FDA Adverse Event Reporting System Database: A Comparative Observational Study
FAERS adverse event analysis for remdesivir, bebtelovimab, molnupiravir, and paxlovid. Top 10 signals for serious adverse drug reactions for remdesivir included death and acute kidney injury, for paxlovid: disease recurrence and rebound, ..
Oct 31
2024
 Steele et al., International Journal of Critical Illness and Injury Science, doi:10.4103/ijciis.ijciis_57_24 Incidence of bradycardia with the use of remdesivir for coronavirus disease of 2019 and risk factor analysis
Retrospective 124 hospitalized COVID-19 patients showing that 49% of patients treated with remdesivir developed bradycardia. Mortality was significantly higher in the bradycardia group (26.2% vs 11.1%).
Sep 18
2024
 Nooruzzaman et al., Nature Communications, doi:10.1038/s41467-024-51924-3 Emergence of transmissible SARS-CoV-2 variants with decreased sensitivity to antivirals in immunocompromised patients with persistent infections
Analysis of 15 immunocompromised patients with persistent SARS-CoV-2 infection showing emergence of putative antiviral resistance mutations in nsp5 and nsp12 following treatment with remdesivir and nirmatrelvir-ritonavir. An infectious SA..
Sep 9
2024
 Kawther et al., Advanced medical journal, doi:10.56056/amj.2024.273 Antiviral drug treatment profiles and clinical outcomes of COVID-19 patients at public hospitals in Erbil city
9% higher mortality (p=0.86). Retrospective 451 hospitalized COVID-19 patients in Iraq showing no significant difference in mortality with remdesivir treatment.
Aug 24
2024
 Duraníková et al., Journal of Clinical Medicine, doi:10.3390/jcm13175013 Prevalence and Risk Factors of Headache Associated with COVID-19
6% higher long COVID (p=0.84) and 36% worse results (p=0.08). Retrospective 295 hospitalized COVID-19 patients in Slovakia showing 35% prevalence of headache, of which 41% of patients had persistent headache 12-15 months after infection. Authors' analysis of long COVID headache is only for the subgr..
Aug 3
2024
 Shen, Y., Doctoral dissertation, University of Cincinnati Hydrolytic Activation and Drug-Drug Interactions of COVID-19 Therapeutics Remdesivir and Molnupiravir: The Role of CES2 Covalent Inhibition and the Impact of Genetic Polymorphism
In vitro and ex vivo study showing significant potential drug-drug interactions between remdesivir and molnupiravir. Author found that remdesivir irreversibly inhibits CES2, an enzyme crucial for activating molnupiravir in the body, which..
Jul 22
2024
 Siami et al., Health Science Reports, doi:10.1002/hsr2.2252 Clinical outcomes and considerations in outpatient with COVID‐19 receiving remdesivir therapy
70% higher hospitalization (p=0.2). Retrospective 514 COVID-19 outpatients showing no significant benefit with remdesivir therapy.
Jul 15
2024
 Choi et al., The Lancet Infectious Diseases, doi:10.1016/S1473-3099(24)00353-0 Comparative effectiveness of combination therapy with nirmatrelvir–ritonavir and remdesivir versus monotherapy with remdesivir or nirmatrelvir–ritonavir in patients hospitalised with COVID-19: a target trial emulation study
267% higher mortality (p=0.07), 600% higher ICU admission (p<0.0001), 686% higher need for oxygen therapy (p<0.0001), and 182% worse results (p<0.0001). Target trial emulation study of 18,196 hospitalized COVID-19 patients in Hong Kong showing significantly higher ICU admission and AKI with remdesivir + paxlovid compared with paxlovid alone, and lower mortality and ventilatory support wit..
Jul 4
2024
 Razia et al., Frontiers in Transplantation, doi:10.3389/frtra.2024.1408289 Remdesivir and molnupiravir had comparable efficacy in lung transplant recipients with mild-to-moderate COVID-19: a single center experience
1520% higher mortality (p=0.0003), 620% higher ventilation (p=0.05), 710% higher ICU admission (p=0.001), and 94% higher hospitalization (p=0.05). Retrospective 113 lung transplant recipients with mild-to-moderate COVID-19 showing higher mortality with remdesivir and molnupiravir in unadjusted analysis, with statistical significance for remdesivir. mAb PrEP and treatment and the dom..
Jul 2
2024
 Gupta et al., Cardiovascular Toxicology, doi:10.1007/s12012-024-09886-x Prevalence, Outcomes, and Predictors of Prolonged Corrected QT Interval in Hydroxychloroquine-Naïve Hospitalized COVID-19 Patients
Retrospective 295 hospitalized COVID-19 patients showing increased risk of prolonged QTc with remdesivir use, without statistical significance, OR 1.84 [0.69 - 4.9]. Azithromycin had no effect on prolonged QTc.
Jul 2
2024
 Anzalone et al., The Journal of Rural Health, doi:10.1111/jrh.12857 Associations between COVID‐19 therapies and outcomes in rural and urban America: A multisite, temporal analysis from the Alpha to Omicron SARS‐CoV‐2 variants
33% higher mortality (p<0.0001) and 8% lower ventilation (p<0.0001). Retrospective 3,018,646 COVID-19 patients in the US showing higher rates of hospitalization, inpatient death, acute kidney injury, major adverse cardiovascular events, and need for mechanical ventilation among rural patients compared to u..
Jun 27
2024
 Kamo et al., In Vivo, doi:10.21873/invivo.13637 Association of Antiviral Drugs for the Treatment of COVID-19 With Acute Renal Failure
Retrospective 176,197 adverse event reports in Japan showing paxlovid and remdesivir associated with increased risk of acute kidney injury (AKI) in COVID-19 patients.
Jun 24
2024
 Sise et al., Clinical Infectious Diseases, doi:10.1093/cid/ciae333 Efficacy and Safety of Remdesivir in People With Impaired Kidney Function Hospitalized for Coronavirus Disease 2019 Pneumonia: A Randomized Clinical Trial
6% higher mortality (p=0.89), 18% lower combined mortality/intubation (p=0.61), and 16% improvement (p=0.5). RCT 243 hospitalized COVID-19 patients with acute kidney injury, chronic kidney disease, or kidney failure showing no significant difference in all-cause mortality or invasive mechanical ventilation with remdesivir. The lower mortality at..
Jun 24
2024
 Lopez et al., Current Clinical Microbiology Reports, doi:10.1007/s40588-024-00229-6 SARS-CoV-2 Resistance to Small Molecule Inhibitors
Review of resistance mutations in SARS-CoV-2 3CLpro and nsp12 that could reduce efficacy of antiviral therapies including nirmatrelvir, ensitrelvir, remdesivir, and favipiravir. Authors identify 39 single mutations across 17 critical resi..
Apr 30
2024
 Milan et al., Acta Medica Philippina, doi:10.47895/amp.v58i7.8392 Factors Associated with Adverse Outcomes among SARS-CoV-2 Positive Children in a Tertiary Government COVID-19 Referral Hospital in the Philippines
122% higher ventilation (p=0.15) and 419% higher ICU admission (p<0.0001). Retrospective 180 hospitalized pediatric COVID-19 patients in the Philippines showing lower mortality with vitamin D and zinc, and higher mortality with remdesivir, all without statistical significance. Remdesivir was given to few patient..
Apr 4
2024
 Melis et al., Scientific Reports, doi:10.1038/s41598-024-57726-3 The metabolic footprint of Vero E6 cells highlights the key metabolic routes associated with SARS-CoV-2 infection and response to drug combinations
In vitro study showing that remdesivir and azithromycin, either alone or in combination, can modify the glycolic-gluconeogenesis pathway in host cells, inhibiting the mitochondrial oxidative damage caused by SARS-CoV-2. Authors use Nuclea..
Apr 3
2024
 Xu et al., Antimicrobial Agents and Chemotherapy, doi:10.1128/aac.01015-23 Two-way pharmacodynamic modeling of drug combinations and its application to pairs of repurposed Ebola and SARS-CoV-2 agents
In silico study supporting the synergistic combination of nitazoxanide and remdesivir for SARS-CoV-2. Authors developed a two-way pharmacodynamic modeling approach to capture the concentration-dependent drug-drug interactions and combined..
Mar 19
2024
 Drouin et al., Scientific Reports, doi:10.1038/s41598-024-57306-5 Clinical and laboratory characteristics of patients hospitalized with severe COVID-19 in New Orleans, August 2020 to September 2021
46% higher severe cases (p<0.0001). Retrospective 456 hospitalized patients in the USA showing an association between remdesivir treatment and increased COVID-19 severity in multivariable analysis, for remdesivir treatment within 7 days and when administered before meeting ..
Mar 7
2024
 Lewandowski et al., Biomedicines, doi:10.3390/biomedicines12030605 Insulin and Metformin Administration: Unravelling the Multifaceted Association with Mortality across Various Clinical Settings Considering Type 2 Diabetes Mellitus and COVID-19
21% higher mortality (p=0.55). Retrospective 430 hospitalized COVID-19 patients with type 2 diabetes in Poland showing lower mortality with metformin and higher mortality with remdesivir, convalescent plasma, and aspirin in univariable analysis. These results were not..
Feb 28
2024
 Sokolski et al., Scientific Reports, doi:10.1038/s41598-024-55407-9 Antiplatelet therapy prior to COVID-19 infection impacts on patients mortality: a propensity score-matched cohort study
no change in mortality (p=1). Retrospective 2,170 hospitalized COVID-19 patients showing no difference in mortality with remdesivir in unadjusted results.
Feb 6
2024
 Yoshida et al., Cureus, doi:10.7759/cureus.61048 (date from preprint) Real-World Efficacy of Ensitrelvir in Hospitalized Patients With COVID-19 in Japan: A Retrospective Observational Study
Retrospective 154 hospitalized COVID-19 patients in Japan showing faster viral clearance and shorter hospitalization with ensitrelvir treatment compared to remdesivir or molnupiravir. There was no significant difference for fever resoluti..
Jan 26
2024
 Wilcock et al., JAMA Health Forum, doi:10.1001/jamahealthforum.2023.5044 Clinical Risk and Outpatient Therapy Utilization for COVID-19 in the Medicare Population
Analysis of Medicare beneficiaries in 2022 showing that outpatient COVID-19 treatments like antivirals and monoclonal antibodies were disproportionately used by patients at lower risk of severe infection and outcomes. Retrospective studie..
Jan 15
2024
 Liao et al., BMC Pulmonary Medicine, doi:10.1186/s12890-024-02850-z Clinical characteristics and outcomes among critically ill patients with cancer and COVID-19-related acute respiratory failure
25% higher mortality (p=0.67). Retrospective study of 215 critically ill COVID-19 patients with respiratory failure showing higher mortality for cancer patients. Remdesivir was used more for non-survivors, without statistical significance. Most patients received remdes..
Jan 8
2024
 Alsaraj et al., Infectious Diseases in Clinical Practice, doi:10.1097/IPC.0000000000001336 Consequence of Antivirals Versus Standard Care on Clinical Situation in Patients With COVID-19
83% higher mortality (p=0.26). RCT 156 COVID-19 patients showing higher mortality with favipiravir and remdesivir overall. Favipiravir and remdesivir were more effective when started earlier, however note that Table 10 compares earlier favipiravir/remdesivir+standard c..
Dec 29
2023
 Chang et al., Medicine, doi:10.1097/MD.0000000000036777 The association between COVID-19 vaccination and confirmed patients with hospitalization in Omicron era: A retrospective study
185% higher mortality (p=0.04). Retrospective 209 hospitalized COVID-19 patients in Taiwan showing higher mortality with a 5-day course of remdesivir compared to other antivirals or no antiviral treatment in multivariable analysis. Adjustments include qSOFA and CCI, wit..
Dec 19
2023
 Muntean et al., Pharmaceuticals, doi:10.3390/ph17010003 Effects of COVID-19 on the Liver and Mortality in Patients with SARS-CoV-2 Pneumonia Caused by Delta and Non-Delta Variants: An Analysis in a Single Centre
45% higher mortality (p=0.03). Retrospective 551 severe/critical COVID-19 patients showing higher mortality and higher risk of drug induced liver injury with remdesivir. Authors appear to have reversed the OR for remdesivir - use was more common in non-survivors (61% v..
Dec 19
2023
 Lombardo et al., Microorganisms, doi:10.3390/microorganisms12010002 Assessing Genomic Mutations in SARS-CoV-2: Potential Resistance to Antiviral Drugs in Viral Populations from Untreated COVID-19 Patients
Analysis of naturally occurring SARS-CoV-2 mutations in genomic regions targeted by remdesivir, molnupiravir, and paxlovid in 4,155 antiviral-naive COVID-19 patients. Authors identified 84 amino-acid substitutions in Nsp12 (RdRp; target o..
Dec 14
2023
 Briciu et al., Pathogens, doi:10.3390/pathogens12121453 Evolving Clinical Manifestations and Outcomes in COVID-19 Patients: A Comparative Analysis of SARS-CoV-2 Variant Waves in a Romanian Hospital Setting
Retrospective 9,049 hospitalized COVID-19 patients in Romania showing increased risk of acute kidney injury and liver injury with remdesivir treatment.
Dec 14
2023
 Seah et al., Health Science Reports, doi:10.1002/hsr2.1698 Remdesivir therapy for severe pediatric COVID‐19 in Singapore: A single‐center retrospective observational cohort study
129% worse recovery (p=0.57). Retrospective 15 pediatric patients hospitalized for severe COVID-19 requiring oxygen and high dependency/intensive care unit (HD/ICU) admission in Singapore, showing no improvement in deescalation from HD/ICU care with remdesivir, howeve..
Dec 6
2023
 Bacigalupo et al., Frontiers in Medicine, doi:10.3389/fmed.2023.1287542 Unveiling patenting strategies of therapeutics and vaccines: evergreening in the context of COVID-19 pandemic
Review of the patenting activity and evergreening approaches for three major COVID-19 antiviral medications - remdesivir, molnupiravir, and favipiravir. Authors found extensive primary and secondary patent filing, with 29 applications cov..
Nov 30
2023
 Uraki et al., iScience, doi:10.1016/j.isci.2023.108147 Antiviral efficacy against and replicative fitness of an XBB.1.9.1 clinical isolate
In vitro and animal study showing that the SARS-CoV-2 omicron subvariant XBB.1.9.1 has similar antigenicity, antiviral susceptibility, and replicative ability compared to XBB.1.5. Casirivimab, imdevimab, tixagevimab, cilgavimab, sotrovima..
Nov 21
2023
 Soltani et al., The Journal of Tehran University Heart Center, doi:10.18502/jthc.v18i3.14114 The Association between Acute Cardiac Injury and Outcomes of Hospitalized Patients with COVID-19: Long-term Follow-up Results from the Sina Hospital COVID-19 Registry, Iran
Retrospective 1,413 hospitalized COVID-19 patients evaluating the association between acute cardiac injury (ACI) and outcomes. Authors include a multivariable analysis showing lower risk of ACI with HCQ and higher risk with remdesivir, wi..
Nov 1
2023
 Amirizadeh et al., Health Science Reports, doi:10.1002/hsr2.1676 The effect of remdesivir on mortality and the outcome of patients with COVID‐19 in intensive care unit: A case–control study
3% higher mortality (p=1), 52% longer ventilation (p=0.17), 27% longer ICU admission (p=0.23), and 24% longer hospitalization (p=0.22). Retrospective 70 COVID-19 ICU patients, 35 receiving remdesivir plus standard treatment and 35 receiving standard treatment only. No significant differences were found for mortality, hospitalization time, ICU time, or ventilation time.
Oct 31
2023
 Ho et al., HCA Healthcare Journal of Medicine, doi:10.36518/2689-0216.1546 A Retrospective Cohort Study Assessing the Impact of Statin Therapy on Hospital Length of Stay and Inpatient Mortality in COVID-19 Patients
62% higher mortality (p<0.0001). Retrospective 26,445 hospitalized COVID-19 patients in the USA, showing higher mortality with remdesivir.
Oct 18
2023
 Tang et al., Science China Life Sciences, doi:10.1007/s11427-023-2369-3 Modeling drug-induced mitochondrial toxicity with human primary cardiomyocytes
In vitro study using adult human primary cardiomyocytes showing remdesivir-induced mitochondrial toxicity, identifying mitochondrial ROS as the primary mediator, and showing action potential prolongation consistent with clinical QT prolon..
Sep 28
2023
 Pochtovyi et al., Vaccines, doi:10.3390/vaccines11101533 In Vitro Efficacy of Antivirals and Monoclonal Antibodies against SARS-CoV-2 Omicron Lineages XBB.1.9.1, XBB.1.9.3, XBB.1.5, XBB.1.16, XBB.2.4, BQ.1.1.45, CH.1.1, and CL.1
In vitro study showing sharply reduced neutralization of SARS-CoV-2 variants XBB.1.9.1, XBB.1.9.3, XBB.1.5, XBB.1.16, XBB.2.4, BQ.1.1.45, CH.1.1, and CL.1 with monoclonal antibodies cilgavimab, tixagevimab, imdevimab, etsevimab, casirivim..
Sep 26
2023
 Hagman et al., Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkad295 Effects of remdesivir on SARS-CoV-2 viral dynamics and mortality in viraemic patients hospitalized for COVID-19
no change in mortality (p=0.97), 40% higher progression (p=0.31), and 29% improved viral clearance (p=0.11). Retrospective 318 hospitalized COVID-19 patients in Sweden, showing improvements in viral clearance but no improvement for mortality with remdesivir treatment.
Sep 25
2023
 Burhan et al., PLOS ONE, doi:10.1371/journal.pone.0290964 Characteristics and outcomes of patients with severe COVID-19 in Indonesia: Lessons from the first wave
15% higher mortality (p=0.23). Retrospective 559 COVID-19 ICU patients in Indonesia, showing higher mortality with remdesivir in unadjusted results, without statistical significance. Note that confounding by indication should be less significant for ICU studies compare..
Sep 16
2023
 Mohd Abd Razak et al., Natural Product Communications, doi:10.1177/1934578X231188861 In Vitro Anti-SARS-CoV-2 Activities of Curcumin and Selected Phenolic Compounds
In vitro study showing that of 9 phenolic compounds tested, only curcumin inhibited SARS-CoV-2 cytopathic effects in infected monkey kidney Vero E6 cells. Curcumin showed antiviral activity against wildtype, alpha, delta, and omicron vari..
Aug 12
2023
 Nadeem et al., Cureus, doi:10.7759/cureus.43389 Effects of Different Anticoagulation Doses on Moderate-to-Severe COVID-19 Pneumonia With Hypoxemia
12% higher mortality (p=1). Retrospective 132 hospitalized COVID-19 patients in the USA, showing no significant difference in mortality with remdesivir in unadjusted results.
Aug 12
2023
 Gratteri et al., Pharmaceuticals, doi:10.3390/ph16081143 Molecular and Structural Aspects of Clinically Relevant Mutations of SARS-CoV-2 RNA-Dependent RNA Polymerase in Remdesivir-Treated Patients
In silico study showing that specific mutations in the SARS-CoV-2 RNA-dependent RNA polymerase (RdRp) may reduce the effectiveness of remdesivir treatment in COVID-19 patients. Authors found that patients with the P323L+G671S+M899I or..
Aug 9
2023
 Mozaffari et al., Clinical Infectious Diseases, doi:10.1093/cid/ciad460 Remdesivir reduced mortality in immunocompromised patients hospitalized for COVID-19 across variant waves: Findings from routine clinical practice.
25% lower mortality (p<0.0001). Retrospective 19,184 immunocompromised patients treated with remdesivir and matched controls, showing lower mortality with treatment. Several authors work at Gilead and the study was funded by Gilead. The majority of patients were treated..
Jul 20
2023
 Jittamala et al., The Journal of Infectious Diseases, doi:10.1093/infdis/jiad275 Clinical antiviral efficacy of remdesivir in COVID-19: an open label, randomized, controlled adaptive platform trial (PLATCOV)
29% improved viral clearance (p<0.0001). High conflict of interest RCT with very low risk patients with high existing immunity, showing faster viral clearance with remdesivir. The viral clearance half-life was very short in both arms. With rapid viral clearance and very low risk..
Jul 17
2023
 Shamsi et al., Canadian Journal of Infectious Diseases and Medical Microbiology, doi:10.1155/2023/5205188 Survival and Mortality in Hospitalized Children with COVID-19: A Referral Center Experience in Yazd, Iran
23% higher mortality (p=0.63). Retrospective 183 hospitalized pediatric COVID-19 patients in Iran, showing no significant difference in mortality with in unadjusted results.
Jun 14
2023
 Shi et al., Journal of Korean Medical Science, doi:10.3346/jkms.2023.38.e217 Clinical Characteristics and Risk Factors for Mortality in Critical COVID-19 Patients Aged 50 Years or Younger During Omicron Wave in Korea: Comparison With Patients Older Than 50 Years of Age
Retrospective 213 critical COVID-19 patients in South Korea, reporting no significant difference in mortality with remdesivir treatment (results not provided).
Jun 10
2023
 Wade et al., Value in Health, doi:10.1016/j.jval.2023.03.2056 Variation in Demographic Characteristics, Socioeconomic Status, Clinical Presentation and Selected Treatments in Mortality Among Patients with a Diagnosis of COVID-19 in the United States
Retrospective analysis of mortality for COVID-19 patients in the USA. Authors do not provide adjusted results, preventing any strong evidence. However it is notable that, despite comparable treatment frequencies, the mortality for patient..
Jun 1
2023
 Rudraraju et al., Stem Cell Reports, doi:10.1016/j.stemcr.2023.05.007 Parallel use of human stem cell lung and heart models provide insights for SARS-CoV-2 treatment
In vitro study showing that SARS-CoV-2 cell entry differs across cell types. ACE2 was required for infection in both lung and cardiac cells, but TMPRSS2 cleavage was required in lung cells, while the endosomal pathway was required in card..
May 19
2023
 Bavaro et al., Viruses, doi:10.3390/v15051199 Efficacy of Remdesivir and Neutralizing Monoclonal Antibodies in Monotherapy or Combination Therapy in Reducing the Risk of Disease Progression in Elderly or Immunocompromised Hosts Hospitalized for COVID-19: A Single Center Retrospective Study
7% lower severe cases (p=0.001). Retrospective 331 hospitalized COVID-19 patients in Italy, showing lower progression with remdesivir. Combination therapy with mAbs was more effective, and improved results were seen for immunocompromised patients.
May 4
2023
 Arfijanto et al., Pathophysiology, doi:10.3390/pathophysiology30020016 Duration of SARS-CoV-2 RNA Shedding Is Significantly Influenced by Disease Severity, Bilateral Pulmonary Infiltrates, Antibiotic Treatment, and Diabetic Status: Consideration for Isolation Period
1% improved viral clearance (p=1). Retrospective 162 hospitalized COVID-19 patients in Indonesia, showing no significant difference in delayed viral clearance with remdesivir treatment in unadjusted results.
Mar 29
2023
 Aweimer et al., Scientific Reports, doi:10.1038/s41598-023-31944-7 Mortality rates of severe COVID-19-related respiratory failure with and without extracorporeal membrane oxygenation in the Middle Ruhr Region of Germany
13% higher mortality (p=0.33). Retrospective 149 patients under invasive mechanical ventilation in Germany showing no significant difference in mortality with remdesivir in unadjusted results.
Mar 16
2023
 Chew et al., Pathogens, doi:10.3390/pathogens12030473 Clinical Predictors for Abnormal ALT in Patients Infected with COVID-19—A Retrospective Single Centre Study
68% higher progression (p=0.4). Retrospective 163 COVID-19 patients in Singapore, showing increased risk of liver injury (abnormal ALT) with acetaminophen in a dose-dependent manner, and with remdesivir, without statistical significance in both cases.
Mar 15
2023
 Kim et al., Journal of Clinical Medicine, doi:10.3390/jcm12062279 Clinical Outcome and Prognosis of a Nosocomial Outbreak of COVID-19
1612% higher mortality (p=0.22). Retrospective 167 nosocomial COVID-19 patients in South Korea, showing higher mortality with remdesivir treatment, without statistical significance.
Feb 28
2023
 Punzalan et al., Frontiers in Immunology, doi:10.3389/fimmu.2023.1123497 Utility of laboratory and immune biomarkers in predicting disease progression and mortality among patients with moderate to severe COVID-19 disease at a Philippine tertiary hospital
42% higher mortality (p=0.12) and 59% higher progression (p=0.001). Prospective study of 400 hospitalized patients in the Philippines, showing higher progression with remdesivir in unadjusted results, without statistical significance.
Feb 21
2023
 Mitsushima et al., International Journal of General Medicine, doi:10.2147/IJGM.S394413 Risk of Underlying Diseases and Effectiveness of Drugs on COVID-19 Inpatients Assessed Using Medical Claims in Japan: Retrospective Observational Study
44% higher mortality (p=0.01). Retrospective 18,566 hospitalized patients in Japan, showing higher mortality with remdesivir treatment.
Feb 15
2023
 Alshamrani et al., Saudi Pharmaceutical Journal, doi:10.1016/j.jsps.2023.02.004 Comprehensive evaluation of six interventions for hospitalized patients with COVID-19: A propensity score matching study
17% lower mortality (p=0.003), 4% lower progression (p=0.12), 43% longer ICU admission (p=0.003), and 7% shorter hospitalization (p=0.25). PSM retrospective 29 hospitals in Saudi Arabia, showing lower mortality with remdesivir treatment.
Feb 13
2023
 Karimi et al., Advances in Animal and Veterinary Sciences, doi:10.17582/journal.aavs/2023/11.3.404.409 The Potential of Melatonin and N-Acetylcysteine on Remdesivir Induced Liver Injury in Covid 19 Patients
RCT 70 hospitalized COVID-19 patients evaluating the effects of N-acetylcysteine (NAC) and melatonin on liver injury induced by remdesivir treatment. NAC 600mg twice daily and melatonin 6mg daily. All patients received remdesivir. Liver e..
Feb 9
2023
 Hartantri et al., The Lancet Regional Health - Southeast Asia, doi:10.1016/j.lansea.2023.100167 Clinical and treatment factors associated with the mortality of COVID-19 patients admitted to a referral hospital in Indonesia
11% lower mortality (p=0.84). Retrospective 689 hospitalized patients in Indonesia, showing no significant difference in mortality with remdesivir treatment.
Jan 20
2023
 Ong et al., Acta Oncologica, doi:10.1080/0284186X.2023.2169079 A cohort study of COVID-19 infection in pediatric oncology patients plus the utility and safety of remdesivir treatment
75% slower recovery (p=0.6), 56% longer hospitalization (p=0.31), and 61% slower viral clearance (p=0.14). Retrospective 18 immunocompromised pediatric COVID-19 patients in Singapore, showing slower viral clearance with remdesivir, without statistical significance.
Nov 10
2022
 De Forni et al., PLoS ONE, doi:10.1371/journal.pone.0276751 Synergistic drug combinations designed to fully suppress SARS-CoV-2 in the lung of COVID-19 patients
Vero E6 in vitro study showing remdesivir and ivermectin or azithromycin to be highly synergistic with 4-13 times lower concentration required for 100% inhibition.
Oct 31
2022
 Cacho et al., Kidney International, doi:10.1016/j.kint.2022.08.001 Use of remdesivir in kidney transplant recipients with SARS-CoV-2 Omicron infection
44% higher severe cases (p=0.58), 73% more moderate/severe cases (p=0.09), and 92% lower hospital discharge (p=0.35). Retrospective 98 kidney transplant recipients with SARS-CoV-2 Omicron infection in Spain, showing no significant difference in mortality with remdesivir treatment. Earlier administration was associated with improved results, although this..
Oct 7
2022
 Mazzotta et al., Journal of Medical Virology, doi:10.1002/jmv.28186 Viral load decrease in SARS‐CoV‐2 BA.1 and BA.2 Omicron sublineages infection after treatment with monoclonal antibodies and direct antiviral agents
Observational study of 521 outpatients with mild-to-moderate COVID-19 showing paxlovid had stronger viral load reduction against Omicron BA.1 and BA.2 variants compared to sotrovimab, molnupiravir, and remdesivir, with the exception of co..
Sep 15
2022
 Behboodikhah et al., Iranian Journal of Science and Technology, Transactions A: Science, doi:10.1007/s40995-022-01351-0 Evaluation of the Costs and Outcomes of COVID-19 Therapeutic Regimens in Hospitalized Patients in Shiraz
38% lower mortality (p=0.21). Retrospective 2,174 hospitalized patients showing no significant differences with remdesivir treatment.
Sep 9
2022
 Kneidinger et al., Infection, doi:10.1007/s15010-022-01914-8 Outcome of lung transplant recipients infected with SARS-CoV-2/Omicron/B.1.1.529: a Nationwide German study
20% lower severe cases (p=0.71). Retrospective 218 COVID+ lung transplant patients in Germany, showing no significant difference in severe cases with early remdesivir use.
Sep 6
2022
 Oku et al., Modern Rheumatology, doi:10.1093/mr/roac104 Risk factors for hospitalization or mortality for COVID-19 in patients with rheumatic diseases: Results of a nation-wide JCR COVID-19 registry in Japan
40% higher mortality (p=0.59). Retrospective 220 COVID-19 patients with rheumatic disease in Japan, showing no significant difference in mortality with remdesivir treatment.
Aug 26
2022
 Raad et al., medRxiv, doi:10.1101/2022.08.25.22279181 International Multicenter Study Comparing Cancer to Non-Cancer Patients with COVID-19: Impact of Risk Factors and Treatment Modalities on Survivorship
42% lower mortality (p=0.009). Retrospective 3,966 COVID-19 patients, 1,115 with cancer, showing lower mortality with remdesivir and higher mortality with convalescent plasma.
Aug 25
2022
 Bowen et al., Open Forum Infectious Diseases, doi:10.1093/ofid/ofac436 Reduction in risk of death among patients admitted with COVID-19 between first and second epidemic waves in New York City
57% higher mortality (p=0.0001). Retrospective 4,631 hospitalized patients in New York, showing higher mortality with remdesivir, and lower mortality with HCQ. Authors suggest that increased mortality during the first epidemic wave was partly due to strain on hospital re..
Aug 1
2022
 Piccicacco et al., Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkac256 Real-world effectiveness of early remdesivir and sotrovimab in the highest-risk COVID-19 outpatients during the Omicron surge
30% lower hospitalization (p=0.47), 52% fewer combined hospitalization/ER visits (p=0.05), and 78% lower progression (p=0.03). Retrospective high-risk outpatients in the USA, 82 treated with remdesivir, 88 with sotrovimab, and 90 control patients, showing significantly lower combined hospitalization/ER visits with both treatments in unadjusted results. The domina..
Jul 14
2022
 Malundo et al., IJID Regions, doi:10.1016/j.ijregi.2022.07.009 Predictors of Mortality among inpatients with COVID-19 Infection in a Tertiary Referral Center in the Philippines
17% higher mortality (p=0.45). Retrospective 1,215 hospitalized patients in the Phillipines, showing no significant difference in outcomes with remdesivir or HCQ use in unadjusted results subject to confounding by indication.
May 31
2022
 Leo et al., Digestive and Liver Disease, doi:10.1016/j.dld.2021.12.014 Hepatocellular liver injury in hospitalized patients affected by COVID-19: Presence of different risk factors at different time points
416% higher progression (p=0.04). Retrospective 292 patients in Switzerland showing liver damage associated with acetaminophen treatment and remdesivir treatment.
May 17
2022
 Merches et al., Archives of Toxicology, doi:10.1007/s00204-022-03306-1 The potential of remdesivir to affect function, metabolism and proliferation of cardiac and kidney cells in vitro
In vitro study showing potential harm with remdesivir in cardiac and kidney cells at clinically relevant concentrations. Mitochondrial toxicity was evident in cardiac cells at 1.6-3.1 µM, including decreased oxygen consumption rates, coll..
May 13
2022
 Zangeneh et al., Obesity Medicine, doi:10.1016/j.obmed.2022.100420 Survival analysis based on body mass index in patients with Covid-19 admitted to the intensive care unit of Amir Al-Momenin Hospital in Arak – 2021
32% lower mortality (p=0.06). Retrospective 193 ICU patients in Iran, showing lower mortality with remdesivir treatment, not reaching statistical significance. This study has multiple data issues: The text states that 134 people died and 59 were discharged. However, i..
Apr 2
2022
 Delandre et al., Pharmaceuticals, doi:10.3390/ph15040445 Antiviral Activity of Repurposing Ivermectin against a Panel of 30 Clinical SARS-CoV-2 Strains Belonging to 14 Variants
In vitro study with 30 COVID-19 strains from 14 variants, showing stronger efficacy with ivermectin compared to CQ and remdesivir, and relatively homogeneous efficacy with ivermectin regardless of strain/variant, in contrast to results fo..
Mar 31
2022
 Killingley et al., Nature Medicine, doi:10.1038/s41591-022-01780-9 Safety, tolerability and viral kinetics during SARS-CoV-2 human challenge in young adults
60% higher progression (p=0.43). SARS-CoV-2 challenge study in 36 low-risk young adults. Infected participants had high viral loads peaking around 5 days post-exposure, mild-to-moderate upper respiratory symptoms, and anosmia, but no severe disease. Remdesivir had no sig..
Mar 25
2022
 Wu et al., Frontiers in Pharmacology, doi:10.3389/fphar.2022.692828 Acute Kidney Injury Associated With Remdesivir: A Comprehensive Pharmacovigilance Analysis of COVID-19 Reports in FAERS
FAERS disproportionality analysis identifying a significant association between remdesivir and AKI, PSM ROR 3.85 [3.11-4.78].
Mar 17
2022
 Zhou et al., Frontiers in Pharmacology, doi:10.3389/fphar.2022.833679 Acute Kidney Injury and Drugs Prescribed for COVID-19 in Diabetes Patients: A Real-World Disproportionality Analysis
FAERS analysis showing significantly increased risk of acute kidney injury with remdesivir.
Mar 14
2022
 Elec et al., International Journal of Infectious Diseases, doi:10.1016/j.ijid.2022.03.015 COVID-19 and Kidney Transplantation: The impact of remdesivir on renal function and outcome - a retrospective cohort study
19% lower mortality (p=0.66), 11% lower ventilation (p=0.73), and 72% higher ICU admission (p=0.01). Retrospective 165 hospitalized COVID-19+ kidney transplant patients, 38 treated with remdesivir, showing no significant difference in mortality, higher ICU admission, and lower ICU mortality. Subject to confounding by time with significan..
Mar 11
2022
 Salehi et al., Research Square, doi:10.21203/rs.3.rs-1362678/v1 Risk factors of death in mechanically ventilated COVID-19 patients: a retrospective multi-center study
37% lower mortality (p=0.01). Retrospective 125 mechanically ventilated ICU patients in Iran, showing lower mortality with remdesivir treatment in unadjusted results.
Feb 28
2022
 Siraj et al., Indian Journal of Clinical Practice, 32:9 Efficacy of Various Treatment Modalities on Patient-related Outcome in Hospitalized COVID-19 Patients – A Retrospective Study
53% lower mortality (p<0.0001). Retrospective 1,000 COVID+ hospitalized patients in India, showing lower mortality with famotidine and remdesivir in multivariable logistic regression.
Feb 28
2022
 Kurniyanto et al., Journal of Clinical Virology Plus, doi:10.1016/j.jcvp.2022.100068 Factors Associated with Death and ICU Referral among COVID-19 Patients Hospitalized in the Secondary Referral Academic Hospital in East Jakarta, Indonesia
460% higher mortality (p=0.0009). Retrospective 477 hospitalized patients in Indonesia, showing higher mortality with remdesivir in unadjusted results.
Feb 7
2022
 Schultz et al., Nature, doi:10.1038/s41586-022-04482-x Pyrimidine inhibitors synergize with nucleoside analogues to block SARS-CoV-2
In vitro and mouse study showing synergistic antiviral effects when combining pyrimidine biosynthesis inhibitors with antiviral nucleoside analogues against SARS-CoV-2. Authors screened 18 thousand drugs and validated 122 with antiviral a..
Jan 19
2022
 Ali et al., Canadian Medical Association Journal, doi:10.1503/cmaj.211698 Remdesivir for the treatment of patients in hospital with COVID-19 in Canada: a randomized controlled trial
12% lower mortality (p=0.21), 47% lower ventilation (p=0.0003), 9% improved recovery (p=0.41), and 11% longer hospitalization (p=0.04). RCT 1,282 hospitalized patients in Canada showing lower mechanical ventilation with remdesivir treatment, but no significant difference for mortality.
Dec 30
2021
 Vermillion et al., Science Translational Medicine, doi:10.1126/scitranslmed.abl8282 Inhaled remdesivir reduces viral burden in a nonhuman primate model of SARS-CoV-2 infection
African green monkey study of inhaled versus IV remdesivir, showing similar efficacy with inhalation. Comparable concentrations of the active triphosphate in the lower respiratory tract were found with ~20x lower dose using inhalation, an..
Dec 29
2021
 Mustafa et al., Exploratory Research in Clinical and Social Pharmacy, doi:10.1016/j.rcsop.2021.100101 Pattern of medication utilization in hospitalized patients with COVID-19 in three District Headquarters Hospitals in the Punjab province of Pakistan
33% lower mortality (p=0.21). Retrospective 444 hospitalized patients in Pakistan, showing lower mortality with remdesivir treatment in unadjusted results, not reaching statistical significance.
Dec 22
2021
 Gottlieb et al., New England Journal of Medicine, doi:10.1056/NEJMoa2116846 Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients
87% lower combined mortality/hospitalization (p=0.008), 72% lower hospitalization (p=0.009), and 29% improved recovery (p=0.31). RCT high-risk outpatients, 279 treated with remdesivir and 283 control patients, median 5 days from symptoms, showing significantly lower hospitalization with treatment.
Dec 13
2021
 Jamir et al., Cureus, doi:10.7759/cureus.20394 Determinants of Outcome Among Critically Ill Police Personnel With COVID-19: A Retrospective Observational Study From Andhra Pradesh, India
8% lower mortality (p=0.77). Retrospective 266 COVID-19 ICU patients in India, showing significantly lower mortality with PVP-I oral gargling and topical nasal use, and non-statistically significant higher mortality with ivermectin and lower mortality with remdesivir..
Nov 12
2021
 Schmidt et al., JAMA Network Open, doi:10.1001/jamanetworkopen.2021.34330 Association Between Androgen Deprivation Therapy and Mortality Among Patients With Prostate Cancer and COVID-19
509% higher severe cases (p<0.0001). Retrospective 1,106 prostate cancer patients, showing higher mortality with remdesivir treatment.
Nov 2
2021
 Sarhan et al., Journal of Infection and Public Health, doi:10.1016/j.jiph.2021.10.024 Efficacy of the early treatment with tocilizumab-hydroxychloroquine and tocilizumab-remdesivir in severe COVID-19 Patients
35% higher mortality (p=0.39) and 35% lower hospital discharge (p=0.39). Small 108 patient RCT comparing HCQ vs. remdesivir in very late stage treatment. All patients received tocilizumab. There were significant unadjusted baseline differences in ventilation and ICU admission. REC-H-PhBSU-21011.
Oct 5
2021
 Kwok et al., Cardiovascular Research, doi:10.1093/cvr/cvab311 Remdesivir induces persistent mitochondrial and structural damage in human induced pluripotent stem cell-derived cardiomyocytes
In vitro study showing that remdesivir induces persistent cardiotoxicity in human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) at clinically relevant concentrations. Authors exposed hiPSC-CMs to remdesivir (0.1-12.5 μM..
Oct 1
2021
 Mozaffari et al., Clinical Infectious Diseases, doi:10.1093/cid/ciab875 Remdesivir treatment in hospitalized patients with COVID-19: a comparative analysis of in-hospital all-cause mortality in a large multi-center observational cohort
12% lower mortality (p=0.003). Retrospective 28,855 remdesivir patients with PSM matched controls, showing lower mortality with treatment.
Sep 14
2021
 Ader et al., Lancet Infectious Diseases, doi:10.1016/S1473-3099(21)00485-0 Remdesivir plus standard of care versus standard of care alone for the treatment of patients admitted to hospital with COVID-19 (DisCoVeRy): a phase 3, randomised, controlled, open-label trial
6% lower mortality (p=0.77) and 10% improved 7-point scale results (p=0.39). RCT 857 hospitalized patients, showing no significant differences with remdesivir treatment. EudraCT2020-000936-23.
Sep 10
2021
 Abd-Elsalam et al., The American Journal of Tropical Medicine and Hygiene, doi:10.4269/ajtmh.21-0606 RETRACTED: Remdesivir Efficacy in COVID-19 Treatment: A Randomized Controlled Trial
This paper was retracted.
Aug 19
2021
 Diaz et al., Clinical Infectious Diseases, doi:10.1093/cid/ciab698 Remdesivir and Mortality in Patients with COVID-19
35% lower mortality (p=0.01). Retrospective 1,138 hospitalized patients in the USA, 286 treated with remdesivir, showing lower mortality with treatment. Age was not included in the adjustments (authors excluded variables that contributed to another score, in this case..
Aug 16
2021
 Eldeen et al., Microbes and Infectious Diseases, doi:10.21608/mid.2021.85877.1177 Comparative study between the therapeutic effect of remdesivir versus hydroxychloroquine in COVID-19 hospitalized patients
Small study comparing 25 HCQ and 25 remdesivir hospitalized patients, reporting faster viral clearance with remdesivir. The article proof is missing the results for the HCQ group. Confounding by time is likely - remdesivir patients were a..
Aug 13
2021
 Hosseini et al., medRxiv, doi:10.1101/2021.08.13.21261992 Another step toward final call on Remdesivir efficacy as a treatment for hospitalized COVID-19 patients: a multicenter open-label trial
Single arm remdesivir trial with 145 hospitalized patients showing no statistically significant difference between "early" and "late" administration, however the treatment delays may be better described as late and ver..
Aug 12
2021
 Elavarasi et al., Lung India, doi:10.4103/lungindia.lungindia_493_21 Clinical features, demography, and predictors of outcomes of SARS-CoV-2 infection at a tertiary care hospital in India: A cohort study
137% higher mortality (p<0.0001). Retrospective 2017 hospitalized patients in India, showing higher mortality with remdesivir in unadjusted results, however no group details are provided and this result is subject to confounding by indication, with authors suggesting trea..
Aug 9
2021
 Kuno et al., Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkab256 The association of remdesivir and in-hospital outcomes for COVID-19 patients treated with steroids
1% lower mortality (p=0.96), no change in ventilation (p=1), and 17% higher ICU admission (p=0.05). PSM retrospective 3,372 hospitalized patients in the USA treated with steroids, showing no significant difference in mortality with remdesivir, but a lower risk of acute kidney injury.
Aug 5
2021
 Anseems et al., Cochrane Database of Systematic Reviews, doi:10.1002/14651858.CD014962 Remdesivir for the treatment of COVID-19
Review of 5 RCTs prior to April 17, 2021 showing mortality RR 0.93 [0.81-1.06] for hospitalized patients.
Jul 30
2021
 Tan et al., Frontiers in Cellular and Infection Microbiology, doi:10.3389/fcimb.2021.700502 Combination Treatment With Remdesivir and Ivermectin Exerts Highly Synergistic and Potent Antiviral Activity Against Murine Coronavirus Infection
In vitro study showing highly synergistic antiviral activity of the combination of ivermectin and remdesivir against murine coronavirus (MHV) infection in RAW264.7 macrophages. Authors found that while remdesivir monotherapy (6 μM) achiev..
Jul 19
2021
 Madan et al., medRxiv, doi:10.1101/2021.07.15.21260600 Remdesivir for the treatment of COVID-19 disease: A retrospective comparative study of patients treated with and without Remdesivir
44% lower mortality (p=0.03). Retrospective 1,262 hospitalized patients, 398 treated with remdesivir, showing unadjusted lower mortality with treatment. This study has multiple serious methodological and data reliability issues: Figure 2A is labeled 'Cumulative Probab..
Jul 15
2021
 Ohl et al., JAMA Network Open, doi:10.1001/jamanetworkopen.2021.14741 Association of Remdesivir Treatment With Survival and Length of Hospital Stay Among US Veterans Hospitalized With COVID-19
6% higher mortality (p=0.66) and 100% longer hospitalization (p=0.001). Retrospective 5,898 hospitalized patients in the USA, 2,374 receiving remdesivir treatment, showing no significant difference in mortality, and a longer time to hospital discharge with treatment.
Jul 13
2021
 Barrat-Due et al., Annals of Internal Medicine, doi:10.7326/M21-0653 Evaluation of the Effects of Remdesivir and Hydroxychloroquine on Viral Clearance in COVID-19
47% worse recovery (p=0.01). Small RCT in Norway showing no significant differences with remdesivir treatment. Add-on trial to WHO Solidarity. Longer term recovery results are from [Patrick-Brown]
Jun 21
2021
 Arch et al., medRxiv, doi:10.1101/2021.06.18.21259072 Evaluation of the effectiveness of remdesivir in treating severe COVID-19 using data from the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, national cohort study
20% lower mortality (p=0.03), 68% higher ventilation (p=0.003), and 47% worse results (p=0.0008). PSM analysis of remdesivir use in the UK showing no significant reduction in mortality at 14 days, and significantly higher mechanical ventilation/ECMO and liver dysfunction. Authors appear to have abandoned this preprint, with no journal..
May 26
2021
 Pourhoseingholi et al., Research Square, doi:10.21203/rs.3.rs-365321/v2 Case Characteristics, Clinical Data, And Outcomes of Hospitalized COVID-19 Patients In Qom Province, Iran: A Prospective Cohort Study
2% higher mortality (p=0.92). Prospective study of 2,468 hospitalized COVID-19 patients in Iran, showing no significant difference with remdesivir treatment. IR.MUQ.REC.1399.013.
May 4
2021
 Liao et al., Journal of the Formosan Medical Association, doi:10.1016/j.jfma.2021.04.026 Assessing Efficacy of Antiviral Therapy for COVID-19 Patients: A Case Study on Remdesivir with Bayesian Synthesis Design and Multistate Analysis
Bayesian synthesis design and multistate analysis of remdesivir results showing 31% [18-44%] lower risk of death and 10% [1-18%] higher recovery.
Apr 30
2021
 Elhadi et al., PLOS ONE, doi:10.1371/journal.pone.0251085 Epidemiology, outcomes, and utilization of intensive care unit resources for critically ill COVID-19 patients in Libya: A prospective multi-center cohort study
11% higher mortality (p=0.65). Prospective study of 465 COVID-19 ICU patients in Libya showing no significant differences with treatment.
Apr 29
2021
 Haji Aghajani et al., Journal of Medical Virology, doi:10.1002/jmv.27053 Decreased In-Hospital Mortality Associated with Aspirin Administration in Hospitalized Patients Due to Severe COVID-19
19% lower mortality (p=0.49). Retrospective 991 hospitalized patients in Iran focusing on aspirin use but also showing results for HCQ, remdesivir, and favipiravir.
Apr 26
2021
 Mohandas et al., Clinical Epidemiology and Global Health, doi:10.1016/j.cegh.2021.100751 Clinical review of COVID-19 patients presenting to a quaternary care private hospital in South India: A retrospective study
104% higher mortality (p=0.03). Retrospective 3,345 hospitalized patients in India, showing higher mortality with remdesivir and tocilizumab in unadjusted results. Confounding by indication is likely.
Apr 7
2021
 Mulhem et al., BMJ Open, doi:10.1136/bmjopen-2020-042042 3219 hospitalised patients with COVID-19 in Southeast Michigan: a retrospective case cohort study
86% higher mortality (p=0.54). Retrospective database analysis of 3,219 hospitalized patients in the USA. Very different results in the time period analysis (Table S2), and results significantly different to other studies for the same medications (e.g., heparin OR 3.06..
Mar 26
2021
 Chen et al., ACS Pharmacology & Translational Science, doi:10.1021/acsptsci.1c00022 Synergistic Inhibition of SARS-CoV-2 Replication Using Disulfiram/Ebselen and Remdesivir
In vitro study showing that disulfiram and ebselen, when combined with remdesivir, synergistically inhibit SARS-CoV-2 replication in Vero E6 cells. Authors demonstrate that these clinically safe Zn-ejector drugs target conserved Zn²⁺ site..
Mar 20
2021
 Mahajan et al., Indian Journal of Anasthesia, doi:10.4103/ija.IJA_149_21 Clinical outcomes of using remdesivir in patients with moderate to severe COVID-19: A prospective randomised study
76% higher mortality (p=0.47) and 112% higher ventilation (p=0.42). Small RCT with 34 remdesivir patients and 36 controls finding no significant difference in clinical outcomes.
Mar 10
2021
 Tsuzuki et al., International Journal of Infectious Diseases, doi:10.1016/j.ijid.2022.02.039 (date from preprint) Efficacy of remdesivir in hospitalized nonsevere COVID-19 patients in Japan: A large observational study using the COVID-19 Registry Japan
4% higher mortality (p=0.21), 2% lower ventilation (p=0.68), and 15% lower progression (p=0.68). Retrospective database analysis of 12,487 hospitalized patients in Japan, showing lower risk of oxygen requirement, but no significant difference in mortality or ventilation/ECMO.
Mar 9
2021
 Goldberg et al., Clinical Microbiology and Infection, doi:10.1016/j.cmi.2021.02.029 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
9% shorter hospitalization (p=0.77) and no change in viral clearance (p=0.98). 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 pat..
Mar 8
2021
 Fateh et al., medRxiv, doi:10.1101/2021.03.05.21251351 A single-center retrospective cohort study of Covid-19 medications: Remdesivir, Favipiravir, Methylprednisolone, Dexamethasone, and Interferon β1a and their combinations
Retrospective 324 hospitalized patients in Iran reporting on the use remdesivir, favipiravir, methylprednisolone, dexamethasone, and interferon β1a and their combinations. There is no control group in this study, however authors suggest t..
Feb 28
2021
 Yeramaneni et al., Gastroenterology, doi:10.1053/j.gastro.2020.10.011 Famotidine Use Is Not Associated With 30-day Mortality: A Coarsened Exact Match Study in 7158 Hospitalized Patients With Coronavirus Disease 2019 From a Large Healthcare System
24% higher mortality (p=0.87). Retrospective 7,158 hospitalized COVID-19 patients in the USA analyzing famotidine treatment, showing no significant difference in mortality with associated remdesivir treatment.
Feb 28
2021
 Bobrowski et al., Molecular Therapy, doi:10.1016/j.ymthe.2020.12.016 Synergistic and Antagonistic Drug Combinations against SARS-CoV-2
In silico and in vitro study showing both synergistic and antagonistic drug combinations against SARS-CoV-2 in Vero E6 cells. Authors screened 73 combinations of 32 drugs and identified 16 synergistic and 8 antagonistic combinations. Nita..
Feb 27
2021
 Touafchia et al., Clinical Microbiology and Infection, doi:10.1016/j.cmi.2021.02.013 Serious bradycardia and remdesivir for coronavirus 2019 (COVID-19): a new safety concerns
Comparison of bradycardia in COVID-19 patients treated with remdesivir compared to those treated with HCQ, lopinavir/ritonavir, tocilizumab or glucocorticoids, finding increased risk of bradycardia with remdesivir.
Jan 28
2021
 Fiege et al., PLOS Pathogens, doi:10.1371/journal.ppat.1009292 Single cell resolution of SARS-CoV-2 tropism, antiviral responses, and susceptibility to therapies in primary human airway epithelium
In vitro study using primary human airway epithelial cells showing heterogeneity in SARS-CoV-2 infection across cell types, with ciliated cells being the predominant cell target. Induction of interferon responses was rare and there was si..
Dec 28
2020
 Shen et al., Fundamentals of Clinical Pharmacology, doi:10.1111/fcp.12643 Remdesivir potently inhibits carboxylesterase-2 through covalent modifications: signifying strong drug-drug interactions
Analysis finding that remdesivir at nanomolar concentrations inhibits carboxylesterase-2 (CES2) through covalent modifications. CES2 is a major drug metabolizing enzyme. Authors conclude that caution must be exercised when remdesivir is u..
Dec 24
2020
 Jeffreys et al., International Journal of Antimicrobial Agents, doi:10.1016/j.ijantimicag.2022.106542 (date from preprint) Remdesivir-ivermectin combination displays synergistic interaction with improved in vitro activity against SARS-CoV-2
In vitro study showing enhanced antiviral activity of ivermectin and remdesivir in combination.
Dec 19
2020
 Gérard et al., Clinical Pharmacology & Therapeutics, doi:10.1002/cpt.2145 Remdesivir and Acute Renal Failure: A Potential Safety Signal From Disproportionality Analysis of the WHO Safety Database
VigiBase retrospective showing a 20x increase in the risk of acute renal failure with remdesivir.
Nov 29
2020
 Ullah et al., International Journal of Sciences, doi:10.18483/ijSci.2417 Efficacy of Remdesivir in Covid-19 Patients; Multicenter Study in Lahore
100% higher mortality (p=0.33) and 250% higher ventilation (p=0.15). Small late stage (hospitalized, <12 days symptoms) remdesivir study showing non-statistically significant higher mortality with treatment. No adjustments were made for differences in the groups. Remdesivir mean age was 49 vs. control 57. ..
Nov 20
2020
 Garibaldi et al., medRxiv, doi:10.1101/2020.11.19.20234153 Effectiveness of remdesivir with and without dexamethasone in hospitalized patients with COVID-19
20% lower mortality (p=0.44) and 35% greater improvement (p<0.0001). Retrospective 303 remdesivir patients and 303 matched controls showing significantly faster clinical improvement, and lower (but not statistically significant) mortality.
Nov 3
2020
 Flisiak et al., Polish Archives of Internal Medicine, doi:10.20452/pamw.15735 Remdesivir-based therapy improved recovery of patients with COVID-19 in the SARSTer multicentre, real-world study
49% lower mortality (p=0.18) and 56% greater improvement (p=0.01). Retrospective study comparing 122 remdesivir patients and 211 lopinavir/ritonavir patients, showing higher rates of clinical improvement with remdesivir and lower mortality (not statistically significant).
Oct 28
2020
 Cohen et al., Science, doi:10.1126/science.abf4549 The ‘very, very bad look' of remdesivir, the first FDA-approved COVID-19 drug
Discussion of the controversial approval of remdesivir as the first FDA-approved drug for COVID-19 treatment in October 2020. Despite mixed results from clinical trials, including the large WHO Solidarity study that showed no significant ..
Oct 20
2020
 El-Solh et al., Journal of Intensive Care Medicine, doi:10.1177/0885066621994476 (date from preprint) Clinical Course and Outcome of COVID-19 Acute Respiratory Distress Syndrome: Data From a National Repository
29% lower mortality (p=0.03). Retrospective 7,816 Veterans Affairs hospitalized patients showing lower mortality with remdesivir.
Oct 15
2020
 SOLIDARITY Trial Consortium, NEJM, doi:10.1056/NEJMoa2023184 (date from preprint) Repurposed antiviral drugs for COVID-19; interim WHO SOLIDARITY trial results
5% lower mortality (p=0.53). WHO SOLIDARITY open-label RCT with 2,750 very late stage (76% on oxygen/ventilation) remdesivir patients, mortality relative risk RR 0.95 [0.81-1.11], p=0.50. Non-ventilated patients show a greater benefit, RR 0.86 [0.72-1.04], p = 0.13.
Oct 8
2020
 Beigel et al., NEJM, doi:10.1056/NEJMoa2007764 Remdesivir for the Treatment of Covid-19 — Final Report
27% lower mortality (p=0.07) and 22% improved recovery (p=0.0005). RCT 1,062 hospitalized patients showing faster recovery time with treatment, median 10 days vs. 15 days for placebo, rate ratio for recovery 1.29, p<0.001. Day 29 mortality was 11.4% with remdesivir and 15.2% with placebo, hazard ratio HR..
Aug 28
2020
 Fried et al., Clinical Infectious Disease, doi:10.1093/cid/ciaa1268 Patient Characteristics and Outcomes of 11,721 Patients with COVID19 Hospitalized Across the United States
61% lower mortality (p=0.02) and 37% higher ventilation (p=0.25). Database analysis of 11,721 hospitalized patients, 48 treated with remdesivir. Data inconsistencies have been found in this study, for example 99.4% of patients treated with HCQ were treated in urban hospitals, compared to 65% of untreate..
Aug 28
2020
 Akinci et al., bioRxiv, doi:10.1101/2020.08.27.270819 Elucidation of remdesivir cytotoxicity pathways through genome-wide CRISPR-Cas9 screening and transcriptomics
In vitro study analyzing the cytotoxicity pathways of remdesivir using genome-wide CRISPR-Cas9 screening and RNA sequencing. Remdesivir treatment significantly repressed nuclear genes encoding mitochondrial respiratory complexes, leading ..
Aug 23
2020
 Pasquini et al., Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkaa321 Effectiveness of remdesivir in patients with COVID-19 under mechanical ventilation in an Italian ICU
16% lower mortality (p=0.03). Retrospective 51 ICU patients under mechanical ventilation, 25 treated with remdesivir, showing lower mortality with treatment.
Aug 21
2020
 Spinner et al., JAMA, doi:10.1001/jama.2020.16349 Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19A Randomized Clinical Trial
35% lower mortality (p=0.5). Late stage (median 8 days from symptom onset) RCT 584 patients with moderate COVID-19 showing (non-statistically significant) lower mortality. 5-day remdesivir had significantly higher odds of a better clinical status distribution on the ..
Jul 24
2020
 Olender et al., Clinical Infectious Diseases, doi:10.1093/cid/ciaa1041 Remdesivir for Severe Coronavirus Disease 2019 (COVID-19) Versus a Cohort Receiving Standard of Care
59% lower mortality (p=0.001). Comparative analysis between remdesivir trial GS-US-540-5773 and a retrospective SOC cohort with similar inclusion criteria, showing lower mortality and higher recovery at day 14 with remdesivir.
Jun 30
2020
 Dubert et al., International Journal of Infectious Diseases, doi:10.1016/j.ijid.2020.06.093 Case report study of the first five COVID-19 patients treated with remdesivir in France
Early report on 5 ICU patients treated with remdesivir highlighting issues with usage in critically ill patients.
Jun 29
2020
 Zhu et al., medRxiv, doi:10.1101/2020.06.22.20136531 Efficacy and Safety of Remdesivir for COVID-19 Treatment: An Analysis of Randomized, Double-Blind, Placebo-Controlled Trials
36% lower mortality (p=0.02). Meta analysis of Beigel and Wang RCTs showing remdesivir significantly decreased mortality (8.18% vs. 12.70%, RR 0.64 [0.44-0.92], p = 0.175).
May 27
2020
 Goldman et al., NEJM, doi:10.1056/NEJMoa2015301 Remdesivir for 5 or 10 Days in Patients with Severe Covid-19
RCT of remdesivir for 5 or 10 days with no placebo control group, showing no significant differences between 5 and 10 day treatment. NCT04292899.
Apr 29
2020
 Wang et al., Lancet, doi:10.1016/S0140-6736(20)31022-9 Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial
9% higher mortality (p=1). Small RCT with 237 hospitalized patients in China with severe COVID-19, not showing statistically significant benefits. 158 treatment patients and 79 control patients. While too small for significance, the subgroup treated within 10 days ..
Apr 10
2020
 Grein et al., NEJM, doi:10.1056/NEJMoa2007016 Compassionate Use of Remdesivir for Patients with Severe Covid-19
Report on compassionate use of remdesivir with 61 severe COVID-19 patients, showing clinical improvement in 36 of 53 patients.
References