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Major Update: Remdesivir for Adults With COVID-19 : A Living Systematic Review and Meta-analysis for the American
Anjum S Kaka1, Roderick MacDonald2, Nancy Greer2
1Minneapolis VA Health Care System and University of Minnesota School of Medicine, Minneapolis, Minnesota (A.S.K., W.D., T.J.W.).
Insights
Remdesivir treatment for COVID-19 likely shows little mortality benefit but may improve recovery rates and reduce serious adverse events. A 5-day course may offer more benefits than a 10-day course for some patients.
Area of Science:
- Infectious Diseases
- Pharmacology
- Critical Care Medicine
Background:
- Remdesivir (RDV) is an antiviral medication investigated for treating coronavirus disease 2019 (COVID-19).
- Previous reviews have assessed RDV efficacy, necessitating updated analyses with emerging data.
Purpose of the Study:
- To conduct an updated systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating remdesivir for COVID-19 in adults.
- To compare remdesivir treatment against control groups across various disease severities.
Main Methods:
- Systematic literature search of RCTs from January 2020 to December 2020.
- Data extraction by one reviewer and verification by a second reviewer.
- Risk of bias assessment using the Cochrane Risk of Bias Tool and GRADE methodology.
Main Results:
- Five RCTs were included, incorporating new large-scale trial data.
- Remdesivir (10-day course) showed little to no reduction in mortality but may decrease mechanical ventilation need.
- Moderate improvements in recovery rates and reductions in serious adverse events were observed; time to recovery may be significantly reduced.
Conclusions:
- Remdesivir treatment in hospitalized adults with COVID-19 offers limited mortality benefit but likely improves recovery and reduces serious harms.
- A 5-day remdesivir course may be more advantageous than a 10-day course for patients not requiring baseline ventilation, offering similar benefits with potentially lower costs.
Background:
Remdesivir is being studied and used for treatment of coronavirus disease 2019 (COVID-19).
Purpose:
To update a previous review of remdesivir for adults with COVID-19, including new meta-analyses of patients with COVID-19 of any severity compared with control.
Data Sources:
Several sources from 1 January 2020 through 7 December 2020.
Study Selection:
English-language, randomized controlled trials (RCTs) of remdesivir for COVID-19. New evidence is incorporated by using living review methods.
Data Extraction:
1 reviewer abstracted data; a second reviewer verified the data. The Cochrane Risk of Bias Tool and GRADE (Grading of Recommendations Assessment, Development and Evaluation) method were used.
Data Synthesis:
The update includes 5 RCTs, incorporating data from a new large RCT and the final results of a previous RCT. Compared with control, a 10-day course of remdesivir probably results in little to no reduction in mortality (risk ratio [RR], 0.93 [95% CI, 0.82 to 1.06]; 4 RCTs) but may result in a small reduction in the proportion of patients receiving mechanical ventilation (RR, 0.71 [CI, 0.56 to 0.90]; 3 RCTs). Remdesivir probably results in a moderate increase in the percentage of patients who recovered and a moderate decrease in serious adverse events and may result in a large reduction in time to recovery. Effect on hospital length of stay or percentage remaining hospitalized is mixed. Compared with a 10-day course for those not requiring ventilation at baseline, a 5-day course may reduce mortality, the need for ventilation, and serious adverse events while increasing the percentage of patients who recovered or clinically improved.
Limitation:
Summarizing findings was challenging because of varying disease severity definitions and outcomes.
Conclusion:
In hospitalized adults with COVID-19, remdesivir probably results in little to no mortality difference but probably improves the percentage recovered and reduces serious harms and may result in a small reduction in the proportion receiving ventilation. For patients not receiving ventilation, a 5-day course may provide greater benefits and fewer harms with lower drug costs than a 10-day course.
Primary Funding Source:
U.S. Department of Veterans Affairs.
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