Taskforce recommendations for remdesivir unchanged following detailed analysis of disease severity subgroups

The Taskforce has completed a comprehensive review to assess the credibility of disease severity subgroups used in its recommendations on remdesivir. This was initiated following the World Health Organisation (WHO) decision to make a conditional recommendation against the use of remdesivir in all hospitalised patients, regardless of disease severity (20 November 2020). This differs from the Taskforce conditional recommendation supporting use in hospitalised adults with moderate to severe COVID-19 who do not require ventilation (invasive or non-invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO)).

The review by the Disease-Modifying Treatment and Chemoprophylaxis Panel and Guidelines Leadership Group, with additional input from virologists and immunologists, concludes that there are several factors that contribute to differences in recommendations between WHO and the Taskforce:

• The Taskforce considers that delineation of subgroups based on disease severity is credible, and that the observed differences in effect on mortality between subgroups is plausible.
• The Taskforce is more certain that the effect of remdesivir on mortality is closer to the true effect than WHO, as certainty was not downgraded due to risk of bias (certainty for mortality outcomes within the Taskforce is moderate, compared with low certainty within WHO).
• As the Taskforce develops recommendations specific to the Australian healthcare context, there are fewer resource limitations and barriers to actioning these recommendations than in many countries within the operational sphere of WHO.

A detailed methods brief outlines the steps taken in this review.