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What is the new NIH guidance from July 17th regarding remdesivir criteria?

Comment by InpharmD Researcher

NIH guidance for remdesivir has actually been updated today (July 24) since July 17th. On July 17th, NIH recommended that if remdesivir supply is limited, to treat COVID-19 patients requiring supplemental oxygen not mechanically ventilated or on ECMO. The July 24 update further clarified the mode of oxygen delivery which excluded recommended use of remdesivir. If oxygen delivery consists of high-flow oxygen, noninvasive or invasive mechanical ventilation, or ECMO; then use of remdesivir is uncertain in these patients due to unknown benefits. Remdesivir for 5 days is still recommended in COVID-19 oxygen-supported patients not on the three stated oxygen delivery methods.
Background

In the July 17th update, the National Institute of Health (NIH) made recommendations to triage the use of remdesivir when supply is limited. The recommendations state to prioritize remdesivir in hospitalized COVID-19 patients who require supplemental oxygen but are not mechanically ventilated or on extracorporeal membrane oxygenation (ECMO). [1-2]

In the July 24 update (today), the NIH further clarified on the mode of oxygen delivery. If the mode of oxygen delivery involves high-flow oxygen, noninvasive or invasive mechanical ventilation, or ECMO; then the NIH offers no recommendation for use of remdesivir in COVID-19 patients who require supplemental oxygen. This recommendation is due to limited evidence and uncertainty whether patients will clinically benefit from use of remdesivir at this stage. COVID-19 patients requiring supplemental oxygen not involving high-flow oxygen, noninvasive or invasive mechanical ventilation, or ECMO are recommended to receive remdesivir for 5 days or until hospital discharge. [1-2]

References:

[1] National Institute of Health (NIH). Remdesivir. Available https://www.covid19treatmentguidelines.nih.gov/antiviral-therapy/remdesivir/. Updated July 24, 2020. Accessed July 24, 2020.
[2] National Institute of Health (NIH). Remdesivir. Available https://www.covid19treatmentguidelines.nih.gov/whats-new/. Updated July 24, 2020. Accessed July 24, 2020.