Journal name: The Lancet

Publishing date: May 21, 2022

Author: WHO Solidarity Trial Consortium

Remdesivir has no significant effects on COVID-19 patients who have already been ventilated, though a small effect against death or ventilation (or both) was observed among other hospitalised patients.

Why does this study matter?

The Solidarity trial among COVID-19 inpatients has previously reported interim mortality analyses for four repurposed antiviral drugs. Lopinavir, hydroxychloroquine, and interferon (IFN)-β1a were discontinued for futility but randomisation to remdesivir continued. This article reports the final results of Solidarity and meta-analyses of mortality in all relevant trials to date.

Study Design

Solidarity enrolled consenting adults (aged ≥18 years) recently hospitalised with, in the view of their doctor, definite COVID-19 and no contraindication to any of the study drugs, regardless of any other patient characteristics. Participants were randomly allocated, in equal proportions between the locally available options, to receive whichever of the four study drugs (lopinavir, hydroxychloroquine, IFN-β1a, or remdesivir) were locally available at that time or no study drug (controls). All patients also received the local standard of care. No placebos were given. The protocol-specified primary endpoint was in-hospital mortality, subdivided by disease severity. Secondary endpoints were progression to ventilation if not already ventilated, and time-to-discharge from the hospital. Final log-rank and Kaplan-Meier analyses are presented for remdesivir and are appended for all four study drugs. Meta-analyses give weighted averages of the mortality findings in this and all other randomised trials of these drugs among hospital inpatients.

Results and Conclusion

The study reports that Remdesivir has no significant effect on patients with COVID-19 who are already being ventilated. Among other hospitalised patients, it has a small effect on death or progression to ventilation (or both).

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