McMaster-led guidelines issued for new COVID-19 treatment

Much has been made recently about the new antiviral drug remdesivir for COVID-19 patients, but a McMaster University-led guideline for physicians warns that it would only be used in the most serious cases, and more research is needed.

The clinical practice peer-reviewed guideline was fast-tracked for publication on July 31 by the prestigious medical journal The BMJ as part of its Rapid Recommendations initiative to produce trustworthy guidelines to help doctors make better decisions, particularly given the world-wide impact of the pandemic.

“Our international guideline panel has given only a weak recommendation that remdesivir be given for treatment of severe COVID-19 in adult patients,” said first author Bram Rochwerg, an associate professor of medicine of McMaster’s Michael G. DeGroote School of Medicine and a critical care physician for Hamilton Health Sciences.

“Most patients with severe COVID-19 would likely choose remdesivir as there may be a potential shorter time to get better, but at this time we strongly support continued research about this drug. Not enough is known at this time.”

The international guideline panel, which included recovered patients as well as medical experts, looked at new evidence showing remdesivir may be effective in reducing recovery time but probably has no important effect on the need for mechanical ventilation and may have little or no effect on length of hospital stay.

They suggest that future research should focus on areas such as optimal dose and duration of therapy, and whether there are specific groups of patients most likely to benefit from remdesivir.

The authors also sound a note of caution about the potential opportunity cost of using remdesivir while the evidence base is still uncertain. As a relatively costly drug that is given intravenously, use of remdesivir may divert funds, time, attention, and workforce away from other potentially worthwhile treatments.

The evidence summary used by the guideline panel was a newer kind of research called a living systematic review and network meta-analysis.

The authors of the living review stress that “the effectiveness of most interventions is uncertain because most of the randomized controlled trials so far have been small and have important study limitations.”

In a linked editorial, The BMJ editors explain that living systematic reviews are useful in fast moving research areas as they allow authors to update previously vetted and peer reviewed evidence summaries as new information becomes available.

“Our team from around the world scours the literature every day to find all of the latest randomized trials of treatments for COVID-19,” said Reed Siemieniuk, study author and PhD candidate of McMaster’s Department of Health Research Methods, Evidence, and Impact.

“The study will be updated frequently so that it can be a reference point for trustworthy evidence on the effectiveness of every treatment through the duration of the pandemic.”