Clinical Microbiology and Infection
The benefits of remdesivir in the treatment of hospitalized patients with Covid-19 remain debated with the National Institutes of Health and the World Health Organization providing contradictory recommendations for and against use.
To evaluate the role of remdesivir for hospitalized inpatients as a function of oxygen requirements.
Beginning with our prior systematic review, we searched MEDLINE using PubMed from January 15, 2021, through January 22, 2022.
Study eligibility criteria
Randomized controlled trials; all languages.
All hospitalized adults with Covid-19.
Remdesivir, in comparison to either placebo, or standard of care.
Assessment of risk of bias
We used the ROB-2 criteria.
Methods of data synthesis
The primary outcome was mortality, stratified by oxygen use (none, supplemental oxygen without mechanical ventilation, and mechanical ventilation). We conducted a frequentist random effects meta-analysis on the risk ratio (RR) scale and, to contextualize the probabilistic benefits, we also performed a Bayesian random effects meta-analysis on the risk difference scale. A ≥1% absolute risk reduction was considered clinically important.
We identified 8 randomized trials, totaling 9157 participants. The RR for mortality comparing remdesivir versus control was 0.71 (95% confidence interval [CI] 0.42-1.22) in the patients who did not require supplemental oxygen; 0.83 (95%CI 0.73-0.95) for nonventilated patients requiring oxygen; and 1.19 (95%CI 0.98-1.44) in the setting of mechanical ventilation. Using neutral priors, the probabilities that remdesivir reduces mortality were 74.7%, 96.9% and 8.9%, respectively. The probability that remdesivir reduced mortality by ≥1% was 88.1% for nonventilated patients requiring oxygen.
Based on this meta-analysis, there is a high probability that remdesivir reduces mortality for nonventilated patients with COVID-19 requiring supplemental oxygen therapy. Treatment guidelines should be re-evaluated.
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