#261 Antivirals for COVID-19
Reading Tools for Practice Article can earn you MainPro+ CreditsJoin Now
Already a CFPCLearn Member? Log in
- Currently >300 RCTs evaluating different COVID-19 treatments underway.1
- Industry supported, double-blind, placebo-controlled trial of 237 admitted (non-ventilated) patients with confirmed COVID-19, oxygen saturation ≤94% and radiographic pneumonia in Wuhan, China.2 Patients were ~66 years old, and received concomitant antibiotics (~90%), steroids (~70%), or anti-virals (18%).
- 28-day mortality: 14% versus 13% (placebo): no difference.
- Duration of mechanical ventilation (days): 7 versus 15.5 (placebo): not statistically different.
- Time to clinical improvement: 21 versus 23 days (placebo) not statistically different.
- Adverse events leading to medication discontinuation: 12% versus 5% (placebo), number needed to harm=15.
- Study ended early (sample size not achieved) due to “outbreak being controlled in Wuhan”.
- Baseline imbalances suggest inadequate allocation concealment.
- Double-blind, placebo-controlled trial of remdesivir. Information from clinical trial registry3 and interim results available via media release;4 1063 hospitalized patients, oxygen saturation ≤94% and radiographic pneumonia.
- Median time to recovery: 11 days versus 15 days (placebo), statistically different.
- Mortality (unknown time frame): 8% versus 11.6% (placebo), not statistically different.
- Another pharmaceutical company press release reported similar outcomes between 5 and 10 days of remdesivir but did not report whether treatment improved outcomes compared to no remdesivir.5
- Other RCTs ongoing.6-8
- Open-label RCT of 199 admitted COVID-19 positive patients with Sp02 <94% in Wuhan, China.9 Patients randomized to lopinavir-ritonavir for 14 days or usual care. Patients were ~58 years and 60% were men.
- 28-day mortality: 19% lopinavir-ritonavir, 25% usual care: not statistically different.
- Time to clinical improvement: no difference: 15 versus 16 days.
- Length of ICU stay shorter: 6 versus 11 days (control), not quite statistically different.
- Adverse events leading to medication discontinuation: 14%.
- Limitations: enrollment suspended when remdesivir became available for clinical trials.
- No RCTs in COVID-19 or other coronaviral infections.10
- Remdesivir is currently only available in Canada through clinical trials.11
- Guidelines do not recommend any COVID-19 specific antiviral treatments.12,13