- WHO recommends against remdesivir for patients hospitalized with severe COVID-19.
- The panel formulating recommendations for this living guideline sees no "important effect" in terms of mortality, need for/duration of mechanical ventilation, or time to clinical improvement.
- A strong recommendation still stands for systemic corticosteroids for severe/critical COVID-19 and against them for nonsevere disease.
Why this matters
- The panel notes low/very low certainty evidence for all outcomes and that it does not interpret the evidence as proving that remdesivir is ineffective.
- See guideline for summary of available data.
- Systemic corticosteroids (200 mg day 1, 100 mg days 5-10) are strongly recommended for treatment of patients with severe, critical COVID-19, even if they are not hospitalized or on oxygen because of limited resources.
- Caution is warranted with corticosteroids in patients with diabetes or tuberculosis, in those who are immunocompromised, or in children.
- Do not use corticosteroids in patients with nonsevere disease regardless of hospitalization status.
- Continue treatment in patients taking them for other conditions.
- Consider systemic corticosteroids if patients worsen.
- For pregnant women with no evidence of infection who are at risk for preterm birth, administer antenatal corticosteroid therapy at weeks 24-34 gestation.
- WHO living guideline on use of remdesivir in patients with severe COVID-19.
- Funding: No specific funding.
- Evolving data.
- Uncertainties persist around outcomes.