Remdesivir Efficacy in COVID-19 Treatment: A Randomized Controlled Trial

Abd-Elsalam, Sherief; Ahmed, Ossama Ashraf; Mansour, Noha O; Abdelaziz, Doaa H; Salama, Marwa; Fouad, Mohamed Hassan Ahmed; Soliman, Shaimaa; Naguib, Ahmed Mohamed; Hantera, Mohamed Sayed; Ibrahim, Ibrahim S; Torky, Mohamed; Dabbous, Hany M; El Ghafar, Mohamed Samir Abd; Abdul-Baki, Enas A; Elhendawy, Mohammed

To date, no antiviral therapy has shown proven clinical effectiveness in treating patients with COVID-19. We assessed the efficacy of remdesivir in hospitalized Egyptian patients with COVID-19. Patients were randomly assigned at a 1:1 ratio to receive either remdesivir (200 mg on the first day followed by 100 mg daily for the next 9 days intravenously infused over 30-60 minutes) in addition to standard care or standard care alone. The primary outcomes were the length of hospital stay and mortality rate. The need for mechanical ventilation was assessed as a secondary outcome. Two hundred patients (100 in each group) completed the study and were included in the final analysis. The remdesivir group showed a significantly lower median duration of hospital stay (10 days) than the control group (16 days; P < 0.001). Eleven of the patients in the remdesivir group needed mechanical ventilation compared with eight patients in the control group (P = 0.469). The mortality rate was comparable between the two groups (P = 0.602). Mortality was significantly associated with older age, elevated C-reactive protein levels, elevated D-dimer, and the need for mechanical ventilation (P = 0.039, 0.003, 0.001, and < 0.001 respectively). Remdesivir had a positive influence on length of hospital stay, but it had no mortality benefit in Egyptian patients with COVID-19. Its use, in addition to standard care including dexamethasone, should be considered, particularly in low- and middle-income countries when other effective options are scarce.