RT Journal Article
SR Electronic
T1 Remdesivir for the treatment of patients in hospital with COVID-19 in Canada: a randomized controlled trial
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E242
OP E251
DO 10.1503/cmaj.211698
VO 194
IS 7
A1 Ali, Karim
A1 Azher, Tanweer
A1 Baqi, Mahin
A1 Binnie, Alexandra
A1 Borgia, Sergio
A1 Carrier, François M.
A1 Cavayas, Yiorgos Alexandroa
A1 Chagnon, Nicolas
A1 Cheng, Matthew P.
A1 Conly, John
A1 Costiniuk, Cecilia
A1 Daley, Peter
A1 Daneman, Nick
A1 Douglas, Josh
A1 Downey, Catarina
A1 Duan, Erick
A1 Duceppe, Emmanuelle
A1 Durand, Madeleine
A1 English, Shane
A1 Farjou, George
A1 Fera, Evradiki
A1 Fontela, Patricia
A1 Fowler, Rob
A1 Fralick, Michael
A1 Geagea, Anna
A1 Grant, Jennifer
A1 Harrison, Luke B.
A1 Havey, Thomas
A1 Hoang, Holly
A1 Kelly, Lauren E.
A1 Keynan, Yoav
A1 Khwaja, Kosar
A1 Klein, Gail
A1 Klein, Marina
A1 Kolan, Christophe
A1 Kronfli, Nadine
A1 Lamontagne, Francois
A1 Lau, Rob
A1 Fralick, Michael
A1 Lee, Todd C.
A1 Lee, Nelson
A1 Lim, Rachel
A1 Longo, Sarah
A1 Lostun, Alexandra
A1 MacIntyre, Erika
A1 Malhamé, Isabelle
A1 Mangof, Kathryn
A1 McGuinty, Marlee
A1 Mergler, Sonya
A1 Munan, Matthew P.
A1 Murthy, Srinivas
A1 O’Neil, Conar
A1 Ovakim, Daniel
A1 Papenburg, Jesse
A1 Parhar, Ken
A1 Parvathy, Seema Nair
A1 Patel, Chandni
A1 Perez-Patrigeon, Santiago
A1 Pinto, Ruxandra
A1 Rajakumaran, Subitha
A1 Rishu, Asgar
A1 Roba-Oshin, Malaika
A1 Rushton, Moira
A1 Saleem, Mariam
A1 Salvadori, Marina
A1 Scherr, Kim
A1 Schwartz, Kevin
A1 Semret, Makeda
A1 Silverman, Michael
A1 Singh, Ameeta
A1 Sligl, Wendy
A1 Smith, Stephanie
A1 Somayaji, Ranjani
A1 Tan, Darrell H.S.
A1 Tobin, Siobhan
A1 Todd, Meaghan
A1 Tran, Tuong-Vi
A1 Tremblay, Alain
A1 Tsang, Jennifer
A1 Turgeon, Alexis
A1 Vakil, Erik
A1 Weatherald, Jason
A1 Yansouni, Cedric
A1 Zarychanski, Ryan
A1 ,
A1 
YR 2022
UL http://www.cmaj.ca/content/194/7/E242.abstract
AB Background: The role of remdesivir in the treatment of patients in hospital with COVID-19 remains ill defined in a global context. The World Health Organization Solidarity randomized controlled trial (RCT) evaluated remdesivir in patients across many countries, with Canada enrolling patients using an expanded data collection format in the Canadian Treatments for COVID-19 (CATCO) trial. We report on the Canadian findings, with additional demographics, characteristics and clinical outcomes, to explore the potential for differential effects across different health care systems.Methods: We performed an open-label, pragmatic RCT in Canadian hospitals, in conjunction with the Solidarity trial. We randomized patients to 10 days of remdesivir (200 mg intravenously [IV] on day 0, followed by 100 mg IV daily), plus standard care, or standard care alone. The primary outcome was in-hospital mortality. Secondary outcomes included changes in clinical severity, oxygen- and ventilator-free days (at 28 d), incidence of new oxygen or mechanical ventilation use, duration of hospital stay, and adverse event rates. We performed a priori subgroup analyses according to duration of symptoms before enrolment, age, sex and severity of symptoms on presentation.Results: Across 52 Canadian hospitals, we randomized 1282 patients between Aug. 14, 2020, and Apr. 1, 2021, to remdesivir (n = 634) or standard of care (n = 648). Of these, 15 withdrew consent or were still in hospital, for a total sample of 1267 patients. Among patients assigned to receive remdesivir, in-hospital mortality was 18.7%, compared with 22.6% in the standard-of-care arm (relative risk [RR] 0.83 (95% confidence interval [CI] 0.67 to 1.03), and 60-day mortality was 24.8% and 28.2%, respectively (95% CI 0.72 to 1.07). For patients not mechanically ventilated at baseline, the need for mechanical ventilation was 8.0% in those assigned remdesivir, and 15.0% in those receiving standard of care (RR 0.53, 95% CI 0.38 to 0.75). Mean oxygen-free and ventilator-free days at day 28 were 15.9 (± standard deviation [SD] 10.5) and 21.4 (± SD 11.3) in those receiving remdesivir and 14.2 (± SD 11) and 19.5 (± SD 12.3) in those receiving standard of care (p = 0.006 and 0.007, respectively). There was no difference in safety events of new dialysis, change in creatinine, or new hepatic dysfunction between the 2 groups.Interpretation: Remdesivir, when compared with standard of care, has a modest but significant effect on outcomes important to patients and health systems, such as the need for mechanical ventilation. Trial registration: ClinicalTrials.gov, no. NCT04330690.