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Maves infectious diseases and critical care medicine services

1Infectious Diseases and Critical Care Medicine Services, Naval Medical Center, San Diego, California, USA, and 2Department of Medicine, Uniformed Services University, Bethesda, Maryland,

USA

	[1]. The National Institutes of Health
	(NIH) and Infectious Diseases Society of			corporation of remdesivir into the IDSA
in the mind at the same time, and	America (IDSA) have produced guide-			and NIH guidelines. More recently, how-
	lines that differ in some areas of emphasis
	but are in agreement in most areas of
Crack-Up,” February 1936	overlap, such as recommending gluco-			Solidarity was an open-label, prag-
The coronavirus disease 2019 (COVID-	corticoids and remdesivir for the treat-
	ment of severe disease [2, 3]. The World
	Health Organization (WHO) has pro-
	duced its own living guideline document,
19) pandemic is the defining event of our	duced its own living guideline document,
19) pandemic is the defining event of our	which differs from the IDSA and NIH			were randomized to receive remde sivir,
	which differs from the IDSA and NIH			were randomized to receive remde sivir,
	recommendations in some key areas [4].			hydroxychloroquine,
	recommendations in some key areas [4].			hydroxychloroquine,
	Significant among these is a recommen-			co-formulated lopinavir-ritonavir, inter-
	Significant among these is a recommen-			co-formulated lopinavir-ritonavir, inter-
	dation against the use of remdesivir.			feron in combination with lopinavir-
to help us make decisions regarding the	dation against the use of remdesivir.			feron in combination with lopinavir-
to help us make decisions regarding the	The	NIH-sponsored	Adaptive
	The	NIH-sponsored	Adaptive
	COVID-19 Treatment Trial (ACTT) is
	COVID-19 Treatment Trial (ACTT) is
	an ongoing, multicenter, international			in-hospital mortality, with initiation of
has improved since those first desperate	an ongoing, multicenter, international			in-hospital mortality, with initiation of
has improved since those first desperate	trial of COVID-19 therapeutics. The first
	trial of COVID-19 therapeutics. The first
	iteration of ACTT, known as ACTT-1,
	iteration of ACTT, known as ACTT-1,
	randomized hospitalized patients with			At the conclusion of the study, death oc-
research.	randomized hospitalized patients with			At the conclusion of the study, death oc-
research.	COVID-19 to receive remdesivir vs			curred in 301 of 2743 (12.5%) patients
	COVID-19 to receive remdesivir vs			curred in 301 of 2743 (12.5%) patients
	placebo for up to 10 days, with time to
	placebo for up to 10 days, with time to
	recovery as the primary endpoint [5].
COVID-19. The first, the Surviving	recovery as the primary endpoint [5].
COVID-19. The first, the Surviving	After monitoring 1063 participants for			the results of ACTT-1, patients receiving
	After monitoring 1063 participants for			the results of ACTT-1, patients receiving
	28 days after enrollment, ACTT-1 re-
	28 days after enrollment, ACTT-1 re-
	ported a reduction in the time to re-
core critical care interventions such as	ported a reduction in the time to re-
core critical care interventions such as	covery with the use of remdesivir, from			patients (59%).
	covery with the use of remdesivir, from			patients (59%).
	15 days with placebo to 10 days with
	remdesivir. Mortality was lower with
	remdesivir in ACTT-1 but did not meet
Received 30 December 2020; editorial decision 3 January	statistical significance. This benefit of			IDSA and NIH guidelines vs the WHO
2021; published online 25 January 2021.	remdesivir was most marked in patients			guidelines. I suggest that we should con-
Correspondence: R. C. Maves, Naval Medical Center, 34800 Bob	remdesivir was most marked in patients			guidelines. I suggest that we should con-
	with hypoxemia requiring only low-flow			sider not whether one trial or one guide-
	with hypoxemia requiring only low-flow			sider not whether one trial or one guide-
	supplemental oxygen (<15 L/minute),
	supplemental oxygen (<15 L/minute),
	whereas patients requiring mechanical			be true. The answer lies in the different
Society of America 2021. This work is written by (a) US	whereas patients requiring mechanical			be true. The answer lies in the different
Society of America 2021. This work is written by (a) US	ventilation did not show any meaningful			information obtained from homoge-
	ventilation did not show any meaningful			information obtained from homoge-

EDITORIAL COMMENTARY • cid 2021:XX (XX XXXX) • 1

7.	Landoni G, Comis M, Conte M, et al. Mortality in	9. Andrews B, Semler MW, Muchemwa L, et al. Effect
multicenter critical care trials: an analysis of interven-		of an early resuscitation protocol on in-hospital

43:1559–68.		tension: a randomized clinical trial. JAMA 2017;

Group. Mortality after fluid bolus in African chil-		10. Law AC, Stevens JP, Walkey AJ. National trends in	lation for severe COVID-19: a randomized phase

		1994-2014. Crit Care Med 2019; 47:1493–6.	196:359–66.

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