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The coronavirus disease 2019 (COVID-19) pandemic has strained health care systems across the globe, necessitating drastic public health measures and prompting a fervent search for effective treatments. The experimental antiviral drug remdesivir (manufactured by Gilead) was granted Emergency Use Authorization by the US Food and Drug Administration in May 2020 for patients hospitalized with severe COVID-19.1 At the time, there had been 2 randomized clinical trials (RCTs) that had compared a 10-day course of remdesivir with placebo. The first, by Wang and colleagues,2 failed to show benefit but recruited only 237 patients and may have been underpowered. The second, the National Institutes of Health–sponsored Adaptive COVID-19 Treatment Trial (ACTT-1), randomized 1063 patients and found that those assigned a 10-day course of remdesivir had a recovery time that was shorter by 4 days (median, 11 vs 15 days) compared with placebo.3 No significant difference was found in mortality between drug (7.1%) and placebo (11.9%) (hazard ratio, 0.70; 95% CI, 0.47-1.04). Since the Emergency Use Authorization was granted, there has been a huge demand for remdesivir from both patients and physicians, generating considerable debate over how to ensure adequate, equitable, and affordable access.4,5
McCreary EK, Angus DC. Efficacy of Remdesivir in COVID-19. JAMA. 2020;324(11):1041–1042. doi:10.1001/jama.2020.16337
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