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. 2021 Jul 15;76(8):1962-1968.
doi: 10.1093/jac/dkab093.

Clinical efficacy and safety of remdesivir in patients with COVID-19: a systematic review and network meta-analysis of randomized controlled trials

Chih-Cheng Lai  1 , Chao-Hsien Chen  2   3 , Cheng-Yi Wang  4 , Kuang-Hung Chen  5 , Ya-Hui Wang  6 , Po-Ren Hsueh  5   7
Affiliations

Clinical efficacy and safety of remdesivir in patients with COVID-19: a systematic review and network meta-analysis of randomized controlled trials

Chih-Cheng Lai et al. J Antimicrob Chemother. .

Abstract

Objectives: We performed a systematic review and network meta-analysis of randomized controlled trials (RCTs) to provide updated information regarding the clinical efficacy of remdesivir in treating coronavirus disease 2019 (COVID-19).

Methods: PubMed, Embase, Cochrane Library, clinical trial registries of ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched for relevant articles published up to 18 November 2020.

Results: Five RCTs, including 13 544 patients, were included in this meta-analysis. Among them, 3839 and 391 patients were assigned to the 10 day and 5 day remdesivir regimens, respectively. Patients receiving 5 day remdesivir therapy presented greater clinical improvement than those in the control group [OR = 1.68 (95% CI 1.18-2.40)], with no significant difference observed between the 10 day and placebo groups [OR = 1.23 (95% CI 0.90-1.68)]. Patients receiving remdesivir revealed a greater likelihood of discharge [10 day remdesivir versus control: OR = 1.32 (95% CI 1.09-1.60); 5 day remdesivir versus control: OR = 1.73 (95% CI 1.28-2.35)] and recovery [10 day remdesivir versus control: OR = 1.29 (95% CI 1.03-1.60); 5 day remdesivir versus control: OR = 1.80 (95% CI 1.31-2.48)] than those in the control group. In contrast, no mortality benefit was observed following remdesivir therapy. Furthermore, no significant association was observed between remdesivir treatment and an increased risk of adverse events.

Conclusions: Remdesivir can help improve the clinical outcome of hospitalized patients with COVID-19 and a 5 day regimen, instead of a 10 day regimen, may be sufficient for treatment. Moreover, remdesivir appears as tolerable as other comparators or placebo.

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Figures

Figure 1.
Figure 1.
Flowchart of study selection. This figure appears in colour in the online version of JAC and in black and white in the print version of JAC.
Figure 2.
Figure 2.
Forest plots among treatment strategies for clinical improvement (a), discharge (b), recovery (c), time to clinical improvement (d) and time to recovery (e).
Figure 3.
Figure 3.
Forest plots among treatment strategies for mortality (a) and time to mortality (b).
Figure 4.
Figure 4.
Forest plots among treatment strategies for risk of adverse events (a) and serious adverse events (b).
Figure 5.
Figure 5.
Summary of the risks of bias in each domain. This figure appears in colour in the online version of JAC and in black and white in the print version of JAC.
See this image and copyright information in PMC

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