Remdesivir for 5 or 10 Days in Patients with Severe Covid-19
Open accessAbstract
BACKGROUND: Remdesivir is an RNA polymerase inhibitor with potent antiviral activity in vitro and efficacy in animal models of coronavirus disease 2019 (Covid-19). METHODS: We conducted a randomized, open-label, phase 3 trial involving hospitalized patients with confirmed SARS-CoV-2 infection, oxygen saturation of 94% or less while they were breathing ambient air, and radiologic evidence of pneumonia. Patients were randomly assigned in a 1:1 ratio to receive intravenous remdesivir for either 5 days or 10 days. All patients received 200 mg of remdesivir on day 1 and 100 mg once daily on subsequent days. The primary end point was clinical status on day 14, assessed on a 7-point ordinal scale. RESULTS: In total, 397 patients underwent randomization and began treatment (200 patients for 5 days and 197 for 10 days). The median duration of treatment was 5 days (interquartile range, 5 to 5) in the 5-day group and 9 days (interquartile range, 5 to 10) in the 10-day group. At baseline, patients randomly assigned to the 10-day group had significantly worse clinical status than those assigned to the 5-day group (P = 0.02). By day 14, a clinical improvement of 2 points or more on the ordinal scale occurred in 64% of patients in the 5-day group and in 54% in the 10-day group. After adjustment for baseline clinical status, patients in the 10-day group had a distribution in clinical status at day 14 that was similar to that among patients in the 5-day group (P = 0.14). The most common adverse events were nausea (9% of patients), worsening respiratory failure (8%), elevated alanine aminotransferase level (7%), and constipation (7%). CONCLUSIONS: In patients with severe Covid-19 not requiring mechanical ventilation, our trial did not show a significant difference between a 5-day course and a 10-day course of remdesivir. With no placebo control, however, the magnitude of benefit cannot be determined. (Funded by Gilead Sciences; GS-US-540-5773 ClinicalTrials.gov number, NCT04292899.).
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Direct comparisons in which the evidence is dominated by unblinded studies were rated down, consistent with GRADE, for risk of bias.
“Direct comparisons in which the evidence is dominated by unblinded studies were rated down, consistent with GRADE, for risk of bias and that is reflected in the rating of the quality of evidence from the network estimate.40”
From Drug treatments for covid-19: living systematic review and network meta-analysis (2020) · cites this paper as [40]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Clinical characteristics of coronavirus disease 2019 in China
Guan, W.-J., Ni, Z.-Y., Hu, Y., Liang, W.-H., Ou, C.-Q., He, J.-X., Liu, L., Shan, H., Lei, C.-L., Hui, D. S. C., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2002032 · Cited by 30,246 · see citing works
Self-citationRichardson, S., Hirsch, J. S., Narasimhan, M., Crawford, J. M., McGinn, T., Davidson, K. W., and the Northwell COVID-19 Research Consortium, Barnaby, D. P., Becker, L. B., Chelico, J. D., et al. (2020) · JAMA · doi:10.1001/jama.2020.6775 · Cited by 9,254 · see citing works
Remdesivir for the Treatment of Covid-19 — Final Report
Beigel, J. H., Tomashek, K. M., Dodd, L. E., Mehta, A. K., Zingman, B. S., Kalil, A. C., Hohmann, E., Chu, H. Y., Luetkemeyer, A., Kline, S., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2007764 · Cited by 7,267 · see citing works
Wang, M., Cao, R., Zhang, L., Yang, X., Liu, J., Xu, M., Shi, Z., Hú, Z., Zhong, W., & Xiao, G. (2020) · Cell Research · doi:10.1038/s41422-020-0282-0 · Cited by 6,967 · see citing works
A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19
Cao, B., Wang, Y., Wen, D., Liu, W., Wang, J., Fan, G., Ruan, L., Song, B., Cai, Y., Wei, M., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2001282 · Cited by 5,187 · see citing works
Wang, Y., Zhang, D., Du, G., Du, R., Zhao, J., Jin, Y., Fu, S., Gao, L., Cheng, Z., Lu, Q., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)31022-9 · Cited by 3,442 · see citing works
Covid-19 — Navigating the Uncharted
Fauci, A. S., Lane, H. C., & Redfield, R. (2020) · New England Journal of Medicine · doi:10.1056/nejme2002387 · Cited by 1,983 · see citing works
Liver injury in COVID-19: management and challenges
Zhang, C., Shi, L., & Wang, F. (2020) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(20)30057-1 · Cited by 1,941 · see citing works
Sheahan, T. P., Sims, A. M., Leist, S. R., Schäfer, A., Won, J. J., Brown, A. J., Montgomery, S. A., Hogg, A., Babusis, D. M., Clarke, M. O., et al. (2020) · Nature Communications · doi:10.1038/s41467-019-13940-6 · Cited by 1,726 · see citing works
A Randomized, Controlled Trial of Ebola Virus Disease Therapeutics
Mulangu, S., Dodd, L. E., Davey, R. T., Mbaya, O. T., Proschan, M. A., Mukadi‐Bamuleka, D., Lusakibanza, M. M., Nzolo, D. B., Tshomba, A. O., Ibanda, A., et al. (2019) · New England Journal of Medicine · doi:10.1056/nejmoa1910993 · Cited by 1,617 · see citing works
Broad-spectrum antiviral GS-5734 inhibits both epidemic and zoonotic coronaviruses
Sheahan, T. P., Sims, A. M., Graham, R. L., Menachery, V. D., Gralinski, L. E., Case, J. B., Leist, S. R., Pyrć, K., Feng, J. Y., Trantcheva, I., et al. (2017) · Science Translational Medicine · doi:10.1126/scitranslmed.aal3653 · Cited by 1,575 · see citing works
Therapeutic efficacy of the small molecule GS-5734 against Ebola virus in rhesus monkeys
Warren, T. K., Jordan, R., Lo, M. K., Ray, A. S., Mackman, R. L., Soloveva, V., Siegel, D. S., Perron, M. J., Bannister, R. M., Hui, H. C., et al. (2016) · Nature · doi:10.1038/nature17180 · Cited by 1,561 · see citing works
Remdesivir for the Treatment of Covid-19 — Preliminary Report
Gillenwater, S., Rahaghi, F., & Hadeh, A. (2020) · New England Journal of Medicine · doi:10.1056/nejmc2022236 · Cited by 1,422 · see citing works
de Wit, E., Feldmann, F., Cronin, J., Jordan, R., Okumura, A., Thomas, T., Scott, D. P., Cihlář, T., & Feldmann, H. (2020) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1922083117 · Cited by 888 · see citing works
COVID-19 pandemic: perspectives on an unfolding crisis
Spinelli, A., & Pellino, G. (2020) · British journal of surgery · doi:10.1002/bjs.11627 · Cited by 859 · see citing works
Clinical benefit of remdesivir in rhesus macaques infected with SARS-CoV-2
Williamson, B. N., Feldmann, F., Schwarz, B. H., Meade-White, K. D., Porter, D., Schulz, J. E., van Doremalen, N., Leighton, I. A., Yinda, C. K., Pérez-Pérez, L., et al. (2020) · Nature · doi:10.1038/s41586-020-2423-5 · Cited by 696 · see citing works
Covid-19 — The Search for Effective Therapy
Baden, L. R., & Rubin, E. J. (2020) · New England Journal of Medicine · doi:10.1056/nejme2005477 · Cited by 324 · see citing works
Characterization and Treatment of SARS-CoV-2 in Nasal and Bronchial Human Airway Epithelia
Pizzorno, A., Padey, B., Julien, T., Trouillet‐Assant, S., Traversier, A., Errazuriz-Cerda, E., Fouret, J., Dubois, J., Gaymard, A., Lescure, F.-X., et al. (2020) · Cell Reports Medicine · doi:10.1016/j.xcrm.2020.100059 · Cited by 242 · see citing works
Mesenchymal stem cell therapy for acute respiratory distress syndrome: from basic to clinics
Qin, H., & Zhao, A. (2020) · Protein & Cell · doi:10.1007/s13238-020-00738-2 · Cited by 145 · see citing works
Remdesivir for COVID-19: challenges of underpowered studies
Norrie, J. D. (2020) · The Lancet · doi:10.1016/s0140-6736(20)31023-0 · Cited by 123 · see citing works
COVID-19: from epidemiology to treatment
Pericàs, J. M., Hernández‐Meneses, M., Sheahan, T. P., Quintana, E., Ambrosioni, J., Sandoval, E., Falces, C., Marcos, M. Á., Tuset, M., Vilella, A., et al. (2020) · European Heart Journal · doi:10.1093/eurheartj/ehaa462 · Cited by 110 · see citing works
Lima, W. G., Brito, J. C. M., Overhage, J., & Nizer, W. S. D. C. (2020) · Archives of Virology · doi:10.1007/s00705-020-04693-5 · Cited by 40 · see citing works
Flick, H., Arns, B. M., Bolitschek, J., Bucher, B., Cima, K., Gingrich, E., Handzhiev, S., Hochmair, M. J., Horak, F., Idzko, M., et al. (2020) · Wiener klinische Wochenschrift · doi:10.1007/s00508-020-01691-0 · Cited by 25 · see citing works
Remdesivir bei Patienten mit COVID-19
Augustin, M., Hallek, M. J., & Nitschmann, S. (2020) · Der Internist · doi:10.1007/s00108-020-00836-7 · Cited by 5 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Wiersinga, W. J., Rhodes, A., Cheng, A. C., Peacock, S. J., & Prescott, H. C. (2020) · JAMA · doi:10.1001/jama.2020.12839 · Cited by 4,609 · see citing works
SARS-CoV-2 Neutralizing Antibody LY-CoV555 in Outpatients with Covid-19
Chen, P., Nirula, A., Heller, B., Gottlieb, R. L., Boscia, J., Morris, J., Huhn, G., Cardona, J., Mocherla, B., Stosor, V., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2029849 · Cited by 1,282 · see citing works
Drug treatments for covid-19: living systematic review and network meta-analysis
Siemieniuk, R. A., Bartoszko, J. J., Zeraatkar, D., Kum, E., Qasim, A., Díaz Martinez, J. P., Izcovich, A., Rochwerg, B., Lamontagne, F., Han, M. A., et al. (2020) · BMJ · doi:10.1136/bmj.m2980 · Cited by 846 · see citing works
Artificial intelligence in COVID-19 drug repurposing
Zhou, Y., Wang, F., Tang, J., Nussinov, R., & Cheng, F. (2020) · The Lancet Digital Health · doi:10.1016/s2589-7500(20)30192-8 · Cited by 636 · see citing works
COVID-19: Review of a 21st Century Pandemic from Etiology to Neuro-psychiatric Implications
Yamamoto, V., Bolanos, J. F., Fiallos, J., Strand, S. E., Morris, K., Shahrokhinia, S., Cushing, T. R., Hopp, L., Tiwari, A., Hariri, R., et al. (2020) · Journal of Alzheimer's Disease · doi:10.3233/jad-200831 · Cited by 100 · see citing works
The serotonin reuptake inhibitor Fluoxetine inhibits SARS-CoV-2
Zimniak, M., Kirschner, L., Hilpert, H., Seibel, J., & Bodem, J. (2020) · doi:10.1101/2020.06.14.150490 · Cited by 139 · see citing works
- Authors
- Goldman, J. D., Lye, D. C. B., Hui, D. S., Marks, K. M., Bruno, R., Montejano, R., Spinner, C. D., Galli, M., Ahn, M.-Y., Nahass, R. G., Chen, Y.-S., SenGupta, D., Hyland, R. H., Osinusi, A. O., Cao, H., Blair, C., Wei, X., Gaggar, A., Brainard, D. M., Towner, W. J., Muñoz, J., Mullane, K. M., Marty, F. M., Tashima, K. T., Diaz, G., & Subramanian, A.
- Affiliations
- NewYork–Presbyterian Hospital (US)
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) — both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong–Prince of Wales Hospital, Hong Kong (D.S.H.); New York–Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie...
- Corresponding author
- Brainard, Diana M.
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2020-11-05
- Volume
- 383
- Issue
- 19
- Pages
- 1827-1837
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC7377062
- OpenAlex
- W3032677067
- Cited by
- 1,362
- References
- 24
- Citations by year
- 2026: 21 · 2025: 29 · 2024: 69 · 2023: 140 · 2022: 275 · 2021: 492 · 2020: 336
- FWCI
- 40.81
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion, public-domain)
- mediaTUM (Technical University of Munich) (submittedVersion)
- Funders
- Gilead Sciences
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Keywords
- remdesivir, COVID-19 pandemic, SARS-CoV-2, treatment duration, antiviral therapy, hospitalized patients, pneumonia, clinical status, adverse events, RNA polymerase inhibitors, respiratory failure, alanine aminotransferase elevation, nausea, constipation, mechanical ventilation avoidance, cost-effectiveness
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, COVID-19 Drug Treatment, Adenosine Monophosphate, Adult, Aged, Alanine, Antiviral Agents, Drug Administration Schedule, Female, Hospitalization, Humans, Male, Middle Aged, Oxygen Inhalation Therapy, Pneumonia, Viral, Treatment Outcome, Coronavirus Infections, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
