Adaptive COVID-19 Treatment Trial - ACTT-1

Oct 13, 2020
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
National Institute of Allergy and Infectious Diseases and others
Date Published:
10/08/2020
Date Updated:
10/13/2020
Original Posted Date:
10/13/2020
References

Contribution To Literature:

The ACTT-1 trial showed that remdesivir was superior to placebo at improving time to recovery in hospitalized COVID-19 patients.

Description:

The goal of the trial was to evaluate remdesivir compared with placebo among patients admitted to the hospital with coronavirus disease 2019 (COVID-19) infection.

Study Design

  • Randomized
  • Parallel
  • Placebo
  • Double-blind
  • Stratification

Patients admitted to the hospital with COVID-19 infection were randomized to remdesivir 200 mg, then 100 mg daily for 9 days (n = 541) versus placebo (n = 521).

  • Total number of enrollees: 1,062
  • Duration of follow-up: 29 days
  • Mean patient age: 59 years
  • Percentage female: 36%
  • Percentage with diabetes: 31%

Inclusion criteria:

  • Patients admitted to the hospital with COVID-19

Principal Findings:

The primary outcome, median recovery time, was 10 days in the remdesivir group compared with 15 days in the placebo group (p < 0.001). The benefit for remdesivir appeared to be greater among those receiving oxygen.

Secondary outcomes:

  • Mortality at 15 days: 6.7% of the remdesivir group compared with 11.9% of the placebo group (p < 0.05)
  • Mortality at 29 days: 11.4% of the remdesivir group compared with 15.2% of the placebo group (p = not significant)
  • Patients who received remdesivir were more likely to have improvement in the ordinal scale score at 15 days (odds ratio 1.5, 95% confidence interval 1.2-1.9) 

Interpretation:

Among patients admitted with COVID-19 infection, remdesivir was superior to placebo. Remdesivir was associated with a shorter recovery time compared with placebo. There was also a suggestion of lower mortality among those randomized to remdesivir. Despite benefit with remdesivir, mortality remains high and additional therapies for this disease are needed.

References:

Beigel JH, Tomashek KM, Dodd LE, et al., on behalf of the ACTT-1 Study Group. Remdesivir for the Treatment of Covid-19 — Final Report. N Engl J Med 2020;Oct 8:[Epub ahead of print].

Clinical Topics: COVID-19 Hub, Prevention

Keywords: Antiviral Agents, COVID-19, Coronavirus, Hospitalization, Oxygen, Primary Prevention, remdesivir, severe acute respiratory syndrome coronavirus 2


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