This is an update of the American College of Physicians' living, rapid practice points on the use of remdesivir for treatment of COVID-19. This update is based on an updated living, rapid systematic review that included studies published through 19 October 2021 and identified 2 new studies meeting inclusion criteria.

This is an update of the American College of Physicians' living, rapid practice points about using remdesivir for treatment of COVID-19, which is based on an updated systematic review done through 10 May 2021. The evidence update identified 1 new study that could inform Practice Point 1. No new studies were identified as supporting evidence for Practice Points 2 or 3. The new study did not have an effect on our prior conclusions and resulted in no changes to the practice points (see the next section and the Supplement). We have changed the term mechanical ventilation to invasive ventilation to better reflect most of the patient populations informing the practice points. We define invasive ventilation as administering supplemental oxygen with positive pressure to the lungs via an endotracheal or tracheostomy tube. The Supplement summarizes the evidence, evidence gaps, and clinical considerations.

Practice points for clinicians developed by the American College of Physicians addressing these questions: What are the effectiveness and harms of remdesivir in hospitalized patients with coronavirus disease 2019 (COVID-19)? Do effectiveness and harms in hospitalized patients with COVID-19 vary by symptom duration, disease severity, and treatment duration?

Remdesivir, a broad-spectrum antiviral agent administered intravenously, was developed and studied as a potential treatment for Ebola virus disease and Marburg virus infection. In vitro and in vivo preclinical studies found antiviral activity for remdesivir against corona-like viruses, including Middle East respiratory syndrome coronavirus, severe acute respiratory syndrome coronavirus (SARS-CoV-1), the circulating human coronaviruses HCoV-OC42 and HCoV-229E, and SARS-CoV-2. Currently, the effectiveness of remdesivir is being tested as a treatment for patients infected with SARS-CoV-2 (COVID-19) and has been authorized for emergency use for treating COVID-19, by the U.S. Food and Drug Administration in the United States, and in other countries. The American College of Physicians (ACP) Scientific Medical Policy Committee (SMPC) based these rapid and living practice points on a systematic evidence review conducted by the U.S. Department of Veterans Affairs (VA) Evidence Synthesis Program in Minneapolis, Minnesota. This version of the practice points, based on a search completed on 3 June 2020 and updated through 31 August 2020, was approved by the ACP's Executive Committee of Board of Regents on behalf of the Board of Regents on 14 August 2020 and submitted to Annals of Internal Medicine on 13 August 2020. Because many studies are planned or under way, literature surveillance is ongoing, with updates currently planned for every 2 months through December 2021. The target audience for these practice points includes clinicians and the public. The target patient population includes all nonpregnant patients with COVID-19.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads among persons in close proximity through droplets, although evidence is still emerging regarding potential airborne transmission. Reducing transmission of SARS-CoV-2 infection in health care and community settings is a major priority, especially in the absence of an effective vaccine or treatment. The use of respiratory personal protective equipment (PPE) may decrease the risk for respiratory infection, although controversy exists around the appropriate types of masks and the situations in which they should be used in community and health care settings for the prevention of SARS-CoV-2 infection. The following practice points (Table 1) are intended for clinicians, patients, and the public. Data on SARS-CoV-2 are limited. These practice points are based on the best available evidence on the effectiveness of N95 respirators, surgical masks, and cloth masks in reducing transmission of infection with SARS-CoV-1, Middle East respiratory syndrome coronavirus (MERS-CoV), and influenza-like or other respiratory viruses in community and health care settings. Evidence about reuse or extended use of N95 respirators in health care settings was also considered.

Using chloroquine or hydroxychloroquine, with or without azithromycin, to prevent coronavirus disease (COVID-19) after infection with novel coronavirus (SARS-CoV-2) or to treat COVID-19 began to receive attention following preliminary reports from in vitro and human studies. While multiple studies are planned or under way, it is imperative to continually synthesize the results from the best available evidence to inform point-of-care decisions about the use of chloroquine or hydroxychloroquine. These practice points are based on a rapid and living systematic evidence review conducted by the University of Connecticut Health Outcomes, Policy, and Evidence Synthesis Group and will be updated as new evidence becomes available. The practice points development and update methods are included in the Appendix. This version of the practice points, based on an evidence review conducted on 17 April 2020, was approved by the American College of Physicians Board of Regents on 4 May 2020 and submitted to Annals of Internal Medicine on 6 May 2020.