Remdesivir for the treatment of COVID-19: A systematic review and meta-analysis

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Clinical Microbiology and Infection

Abstract

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.

Objectives

To evaluate the role of remdesivir for hospitalized inpatients as a function of oxygen requirements.

Data sources

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.

Participants

All hospitalized adults with Covid-19.

Interventions

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.

Results

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.

Conclusions

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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