• Karim Ali, Tanweer Azher, Mahin Baqi, Alexandra Binnie, Sergio Borgia, François M Carrier, Yiorgos Alexandroa Cavayas, Nicolas Chagnon, Matthew P Cheng, John Conly, Cecilia Costiniuk, Peter Daley, Nick Daneman, Josh Douglas, Catarina Downey, Erick Duan, Emmanuelle Duceppe, Madeleine Durand, Shane English, George Farjou, Evradiki Fera, Patricia Fontela, Rob Fowler, Michael Fralick, Anna Geagea, Jennifer Grant, Luke B Harrison, Thomas Havey, Holly Hoang, Lauren E Kelly, Yoav Keynan, Kosar Khwaja, Gail Klein, Marina Klein, Christophe Kolan, Nadine Kronfli, Francois Lamontagne, Rob Lau, Todd C Lee, Nelson Lee, Rachel Lim, Sarah Longo, Alexandra Lostun, Erika MacIntyre, Isabelle Malhamé, Kathryn Mangof, Marlee McGuinty, Sonya Mergler, Matthew P Munan, Srinivas Murthy, Conar O'Neil, Daniel Ovakim, Jesse Papenburg, Ken Parhar, Seema Nair Parvathy, Chandni Patel, Santiago Perez-Patrigeon, Ruxandra Pinto, Subitha Rajakumaran, Asgar Rishu, Malaika Roba-Oshin, Moira Rushton, Mariam Saleem, Marina Salvadori, Kim Scherr, Kevin Schwartz, Makeda Semret, Michael Silverman, Ameeta Singh, Wendy Sligl, Stephanie Smith, Ranjani Somayaji, TanDarrell H SDHSNiagara Health (Ali, Tsang), St. Catharines, Ont.; Biomedical Sciences (Azher), Memorial University of Newfoundland, St. John's, Nfld.; William Osler Health System (Baqi, Binnie, Borgia, Havey), Brampton, Ont.; Hôpital du Sacré-Coeur de M, Siobhan Tobin, Meaghan Todd, Tuong-Vi Tran, Alain Tremblay, Jennifer Tsang, Alexis Turgeon, Erik Vakil, Jason Weatherald, Cedric Yansouni, Ryan Zarychanski, Canadian Treatments for COVID-19 (CATCO), and Association of Medical Microbiology and Infectious Disease Canada (AMMI) Clinical Research Network and the Canadian Critical Care Trials Group.
• Niagara Health (Ali, Tsang), St. Catharines, Ont.; Biomedical Sciences (Azher), Memorial University of Newfoundland, St. John's, Nfld.; William Osler Health System (Baqi, Binnie, Borgia, Havey), Brampton, Ont.; Hôpital du Sacré-Coeur de Montréal (Cavayas), Montréal, Que.; Emergency Department (Chagnon), Montfort Hospital, Ottawa, Ont.; Departments of Pediatrics (Fontela, Papenburg), Surgery and Critical Care Medicine (Khwaja), McGill University, Montréal, Que.; Divisions of Infectious Diseases (Cheng, Costiniuk, Harrison, M. Klein, Kronfli, T. Lee, Semret, Yansouni), Chronic Viral Illness Service (Costiniuk, M. Klein), Medical Microbiology (Cheng, Yansouni), Internal Medicine (Malhamé, T. Lee), and Infectious Diseases and Immunity in Global Health Program (M. Klein, Kronfli, T. Lee, Papenburg) McGill University Health Centre, Montréal, Que.; Division of Respirology (Lim, Weatherald), Cumming School of Medicine (Conly, Somayaji), and Departments of Critical Care Medicine (Parhar), Repiratory Medicine (Tremblay) and Interventional Pulmonary Medicine (Vakil), University of Calgary, Calgary, Alta.; Health Sciences Centre (Tremblay), University of Calgary, Calgary, Alta.; Discipline of Laboratory Medicine (Daley), Memorial University of Newfoundland, St. John's, Nfld.; Lion's Gate Hospital (Douglas), Vancouver, BC; CCTS at Sunnybrook Research Institute - Centre for Clinical Trial Support (Downey, G. Klein, Lau, Longo, Mangoff, Mergler, Patel, Rajakumaran, Roba-Oshin, Saleem, Tobin, Todd), Toronto, Ont.; Departments of Medicine and Critical Care Medicine (Fowler) and Division of Infectious Diseases (Daneman), Sunnybrook Hospital, Toronto, Ont.; Department of Critical Care Medicine (Pinto, Rishu), Sunnybrook Health Sciences Centre, Toronto, Ont.; Division of Critical Care (Duan), Department of Medicine (Tsang), McMaster University, Hamilton, Ont.; Departments of Anesthesiology (Carrier), Medicine (Duceppe, Kolan), Intensive Care Medicine (Carrier) and Internal Medicine (Duceppe, Kolan) and Internal Medicine Service (Durand), Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Que.; Departments of Medicine (English) and Infectious Diseases (McGuinty), The Ottawa Hospital, Ottawa, Ont.; Department of Medicine (English), Ottawa Hospital Research Institute, Ottawa, Ont.; Niagara Health (Farjou, Tsang), St. Catharines, Ont.; Markham Stouffville Hospital (Fera), Markham, Ont.; Division of General Internal Medicine (Fralick), Department of Medicine, Sinai Health System; Department of Medicine and Critical Care Medicine (Geagea, Lostun), North York General Hospital, Toronto, Ont.; Departments of Pediatrics (Murthy) and Pathology and Laboratory Medicine (Grant), Faculty of Medicine, University of British Columbia, Vancouver, BC; Island Health Authority (Ovakim), University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Hoang), Department of Medicine, Grey Nuns Community Hospital, Edmonton, Alta.; Department of Pharmacology and Therapeutics (Kelly), George and Fay Yee Centre for Healthcare Innovation, University of Manitoba; Departments of Infectious Disease and Medical Microbiology (Keynan) and Internal Medicine (Zarychanski), University of Manitoba, Winnipeg, Man.; Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke (Lamontagne), Sherbrooke, Que.; Departments of Critical Care (MacIntyre, Sligl) and Medicine (Singh, Smith), Division of Infectious Diseases (O'Neil), University of Alberta, Edmonton, Alta.; Department of Critical Care Medicine (Munan), Misericordia Community Hospital, Edmonton, Alta.; Misericordia Hospital - Covenant Health (Scherr), Edmonton, Alta.; St. Joseph's Health Care (Parvathy), London, Ont.; Department of Medicine (Perez-Patrigeon), Queen's University, Kingston, Ont.; Queensway Carleton Hospital (Rushton), Nepean, Ont.; Public Health Agency of Canada (Salvadori), Ottawa, Ont.; Unity Health Toronto (Schwartz), Toronto, Ont.; Dalla Lana School of Public Health (N. Lee, Schwartz), University of Toronto, Toronto, Ont.; Department of Medicine (Silverman), Western University, London, Ont.; Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; Department of Anesthesiology and Critical Care Medicine (Turgeon, Tran), CHU de Québec-Université Laval, Québec, Que.
• CMAJ. 2022 Feb 22; 194 (7): E242E251E242-E251.

BackgroundThe role of remdesivir in the treatment of patients in hospital with COVID-19 remains ill defined in a global context. The World Health Organization Solidarity randomized controlled trial (RCT) evaluated remdesivir in patients across many countries, with Canada enrolling patients using an expanded data collection format in the Canadian Treatments for COVID-19 (CATCO) trial. We report on the Canadian findings, with additional demographics, characteristics and clinical outcomes, to explore the potential for differential effects across different health care systems.MethodsWe performed an open-label, pragmatic RCT in Canadian hospitals, in conjunction with the Solidarity trial. We randomized patients to 10 days of remdesivir (200 mg intravenously [IV] on day 0, followed by 100 mg IV daily), plus standard care, or standard care alone. The primary outcome was in-hospital mortality. Secondary outcomes included changes in clinical severity, oxygen- and ventilator-free days (at 28 d), incidence of new oxygen or mechanical ventilation use, duration of hospital stay, and adverse event rates. We performed a priori subgroup analyses according to duration of symptoms before enrolment, age, sex and severity of symptoms on presentation.ResultsAcross 52 Canadian hospitals, we randomized 1282 patients between Aug. 14, 2020, and Apr. 1, 2021, to remdesivir (n = 634) or standard of care (n = 648). Of these, 15 withdrew consent or were still in hospital, for a total sample of 1267 patients. Among patients assigned to receive remdesivir, in-hospital mortality was 18.7%, compared with 22.6% in the standard-of-care arm (relative risk [RR] 0.83 (95% confidence interval [CI] 0.67 to 1.03), and 60-day mortality was 24.8% and 28.2%, respectively (95% CI 0.72 to 1.07). For patients not mechanically ventilated at baseline, the need for mechanical ventilation was 8.0% in those assigned remdesivir, and 15.0% in those receiving standard of care (RR 0.53, 95% CI 0.38 to 0.75). Mean oxygen-free and ventilator-free days at day 28 were 15.9 (± standard deviation [SD] 10.5) and 21.4 (± SD 11.3) in those receiving remdesivir and 14.2 (± SD 11) and 19.5 (± SD 12.3) in those receiving standard of care (p = 0.006 and 0.007, respectively). There was no difference in safety events of new dialysis, change in creatinine, or new hepatic dysfunction between the 2 groups.InterpretationRemdesivir, when compared with standard of care, has a modest but significant effect on outcomes important to patients and health systems, such as the need for mechanical ventilation. Trial registration: ClinicalTrials.gov, no. NCT04330690.© 2022 CMA Impact Inc. or its licensors.

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