Intended for healthcare professionals

Practice Rapid Recommendations

Remdesivir for severe covid-19: a clinical practice guideline

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2924 (Published 30 July 2020) Cite this as: BMJ 2020;370:m2924

Visual summary of recommendation

Population Does not apply to: Disease severity Mild Moderate Severe Applies to people withat least one of: Patients with mild or moderate covid-19 Pediatric patients Respiratory rate >30 Respiratory distress SpO 2 <94% on room air Requires intensivecare admission This recommendation applies onlyto people with these characteristics: Adults withconfirmed covid-19
Recommendation 1 We suggest remdesivir rather than no remdesivir in patients with severe covid-19 Usual supportive care Remdesivir or 100 mg intravenously daily for 5-10 days No remdesivir Strong All or nearly all informed people would likely want usual supportive care. Benefits would outweigh harms for almost everyone Weak Most people would likely want usual supportive care. Benefits would outweigh harms for the majority, but not for everyone Weak Most people would likely want Remdesivir. Benefits would outweigh harms for the majority, but not for everyone Strong All or nearly all informed people would likely want remdesivir. Benefits would outweigh harms for almost everyone Resource limited settings Remdesivir is a new drug with uncertain benefits and undetermined cost-effectiveness, not yet approved for marketing or reimbursed for use in many countries. The significant opportunity costs and potential to exacerbate existing health inequities in resource-limited settings may well justify policy decisions not to offer remdesivir to patients until more conclusive evidence is available.
Recommendation 2 Randomised controlled trials examining remdesivir in patients with covid-19 should continue pending further data Further information is required to identify subgroups of covid-19 patients that are more or less likely to benefit from therapy Further information is necessary to raise the quality of evidence for all outcomes Need for further evidence We place a high value on ensuring that, ultimately, high quality evidence will be available regarding the impact of remdesivir on all critical outcomes. This is necessary to ensure that we will be able to make wise decisions regarding the relative merits of emerging treatments. For example, establishing the magnitude of impact (if any) of remdesivir on mortality will be crucial

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