From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
The current NHS guidelines for managing COVID-19 positive inpatients should prioritize the use of remdesivir plus dexamethasone for patients requiring supplemental oxygen, as it has been shown to lower mortality risk and improve clinical outcomes, as demonstrated in the most recent study 1.
Key Recommendations
- For mild cases, management includes monitoring vital signs, maintaining hydration, and providing symptomatic relief with paracetamol for fever and pain.
- For moderate to severe cases requiring oxygen, dexamethasone 6mg once daily for up to 10 days is recommended, and remdesivir should be considered, typically given as a 3-day course 1.
- For severely ill patients, tocilizumab or sarilumab (IL-6 inhibitors) may be administered alongside dexamethasone.
- Respiratory support should be escalated as needed, from supplemental oxygen to continuous positive airway pressure (CPAP) or mechanical ventilation for those with worsening respiratory failure.
- Thromboprophylaxis with low molecular weight heparin is standard unless contraindicated.
- Infection control measures include isolating patients in single rooms or COVID-19 cohort areas, with staff using appropriate PPE including FFP3 masks for aerosol-generating procedures.
Rationale
The use of remdesivir plus dexamethasone has been shown to reduce mortality risk and improve clinical outcomes in patients hospitalized for COVID-19, as demonstrated in the most recent study 1. This study found that remdesivir plus dexamethasone was associated with lower mortality risk compared to dexamethasone alone across all levels of baseline respiratory support. The evidence from 2, 3, and 4 also supports the use of remdesivir in hospitalized patients with COVID-19, particularly those requiring supplemental oxygen. However, the study 1 is the most recent and highest quality study, and its findings should be prioritized.
Considerations
- The use of remdesivir plus dexamethasone should be considered on a case-by-case basis, taking into account the individual patient's disease severity, comorbidities, and other factors.
- Close monitoring of patients receiving remdesivir is necessary to minimize the risk of adverse effects.
- The guidelines should be regularly updated to reflect the latest evidence and changes in the epidemiology of COVID-19.