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Meta-Analysis
. 2022 Feb 2;48(1):e20210393.
doi: 10.36416/1806-3756/e20210393. eCollection 2022.

Use of remdesivir in patients with COVID-19: a systematic review and meta-analysis

[Article in English, Portuguese]
Suzana E Tanni  1 , Antonio Silvinato  2 , Idevaldo Floriano  3 , Hélio A Bacha  4 , Alexandre Naime Barbosa  5 , Wanderley M Bernardo  6
Affiliations
Meta-Analysis

Use of remdesivir in patients with COVID-19: a systematic review and meta-analysis

[Article in English, Portuguese]
Suzana E Tanni et al. J Bras Pneumol. .

Abstract
in English, Portuguese

Objective: Studies in the literature regarding the use of remdesivir to treat COVID-19 patients have shown conflicting results. This study sought to answer questions related to the use of remdesivir for the treatment of patients hospitalized with moderate to severe COVID-19.

Methods: This was a systematic review and meta-analysis including phase 3 randomized clinical trials (RCTs) and observational cohort studies selected from various databases, comparing patients hospitalized with moderate to severe COVID-19 receiving remdesivir and controls.

Results: A total of 207 studies were retrieved, 9 of which met the eligibility criteria and were included in the study. The meta-analysis using RCTs alone showed no statistically significant differences regarding mortality or use of mechanical ventilation/extracorporeal membrane oxygenation between remdesivir and control groups, and the quality of evidence was moderate and low, respectively. The use of remdesivir increased the recovery rate by 6% (95% CI, 3-9); p = 0.004) and the clinical improvement rate by 7% (95% CI, 1-14); p = 0.02). Additionally, no significant differences in mortality were found between remdesivir and control groups when the meta-analysis used observational cohort studies alone (risk difference = -0.01 (95% CI, -0.02 to 0.01; p = 0.32), the quality of evidence being moderate, and the risk of adverse events was 4% ([95% CI, -0.08 to 0.01]; p = 0.09).

Conclusions: The use of remdesivir for the treatment of patients with moderate to severe COVID-19 had no significant impact on clinically important outcomes.

Objetivo:: Estudos na literatura sobre o uso de remdesivir no tratamento de pacientes com COVID-19 têm apresentado resultados divergentes. O objetivo deste estudo foi responder a perguntas a respeito do uso de remdesivir no tratamento de pacientes hospitalizados com COVID-19 moderada a grave.

Métodos:: Trata-se de uma revisão sistemática e meta-análise de ensaios clínicos controlados randomizados (ECR) de fase 3 e estudos observacionais de coorte recuperados de diversos bancos de dados, comparando pacientes hospitalizados com COVID-19 moderada a grave recebendo remdesivir a controles.

Resultados:: Foram recuperados 207 estudos, dos quais 9 preencheram os critérios de elegibilidade e foram incluídos no estudo. A meta-análise somente dos ECR não mostrou diferenças estatisticamente significativas entre os grupos remdesivir e controle quanto à mortalidade ou ao uso de ventilação mecânica/oxigenação por membrana extracorpórea, e a qualidade das evidências foi moderada e baixa, respectivamente. O uso de remdesivir aumentou a taxa de recuperação em 6% (IC95%: 3-9; p = 0,004) e a taxa de melhora clínica em 7% (IC95%: 1-14; p = 0,02). Além disso, não foram observadas diferenças significativas entre os grupos remdesivir e controle quanto à mortalidade quando a meta-análise concentrou-se apenas nos estudos observacionais de coorte [diferença de risco = −0,01 (IC95%: −0,02 a 0,01); p = 0,32; qualidade das evidências: moderada], e o risco de eventos adversos foi de 4% (IC95%: −0,08 a 0,01; p = 0,09).

Conclusões:: O uso de remdesivir no tratamento de pacientes com COVID-19 moderada a grave não teve impacto significativo em desfechos clinicamente importantes.

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Conflict of interest statement

CONFLICT OF INTEREST: None declared.

Figures

Figure 1
Figure 1. Flow chart of study selection based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Figure 2
Figure 2. Risk of bias for nonrandomized studies.a
Figure 3
Figure 3. Meta-analyses and forest plots (based on randomized clinical trials) between intervention (remdesivir/standard of care [SOC]) and control (placebo/SOC) groups regarding mortality in 29 days (in A); patient recovery rate in 29 days (in B); clinical improvement rate in 29 days (in C); use of mechanical ventilation/extracorporeal membrane oxygenation in 29 days (in D); and severe adverse events in 29 days (in E). RDV: remdesivir; M-H: Mantel-Haenszel (method); and df: degrees of freedom.
Figure 4
Figure 4. Meta-analysis and forest plot (based on observational cohort studies) between intervention (remdesivir/standard of care [SOC]) and SOC groups regarding mortality in 28 days. RDV: remdesivir; M-H: Mantel-Haenszel (method); and df: degrees of freedom.
See this image and copyright information in PMC

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