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Meta-Analysis
. 2024 Jan;39(1):160-171.
doi: 10.3904/kjim.2023.357. Epub 2023 Dec 28.

The effects of remdesivir on mortality and the requirement for mechanical ventilation in patients with COVID-19: a systematic review stratified by disease severity

Seungeun Ryoo  1   2 , Miyoung Choi  1 , Su-Yeon Yu  3 , Young Kyung Yoon  4 , Kyungmin Huh  5 , Eun-Jeong Joo  6
Affiliations
Meta-Analysis

The effects of remdesivir on mortality and the requirement for mechanical ventilation in patients with COVID-19: a systematic review stratified by disease severity

Seungeun Ryoo et al. Korean J Intern Med. 2024 Jan.

Abstract

Background/aims: The effectiveness of remdesivir treatment in reducing mortality and the requirement for mechanical ventilation (MV) remains uncertain, as randomized controlled trials (RCTs) have produced conflicting results.

Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and other data resources to find RCTs published prior to April 10, 2023. The selection of studies, assessment of risk of bias, and meta-analysis were conducted according to PRISMA guidelines. The primary outcomes were all-cause mortality and the need to initiate MV.

Results: A total of 5,068 articles were screened, from eight RCTs comprising 11,945 patients. The meta-analysis found that, compared to standard care or placebo, remdesivir treatment provided no significant all-cause mortality benefit (pooled risk ratio [RR], 0.93; 95% confidence interval [CI], 0.85-1.02; 8 studies; high certainty evidence), while subgroup analyses revealed a trend towards reduced mortality among patients requiring oxygen but not MV (pooled RR, 0.88; 95% CI, 0.77-1.00; 6 studies; I2 = 4%). The need to initiate MV (pooled RR, 0.74; 95% CI, 0.59-0.94; 7 studies; moderate certainty evidence) in remdesivir-treated patients was also reduced compared to controls. Remdesivir significantly increased clinical improvement and discharge and significantly reduced serious adverse events.

Conclusion: In this systematic review and meta-analysis of RCTs, it was found that remdesivir treatment did not show a substantial decrease in the risk of mortality. However, it was linked to a reduction in the necessity for additional ventilatory support, suggesting remdesivir could be beneficial for COVID-19 patients, particularly those who are not on MV.

Keywords: COVID-19; COVID-19 drug treatment; Mortality; Systematic review; Ventilators, mechanical.

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Conflict of interest statement

Conflicts of interest

The author discloses no conflicts.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) study flowchart.
Figure 2
Figure 2
Forest plot of all-cause mortality. Meta-analysis of eight randomized controlled trials revealed that remdesivir treatment failed to reduce all-cause mortality compared to the control arms, except in group requiring oxygen but not mechanical ventilation.
Figure 3
Figure 3
Forest plot of the need to initiate mechanical ventilation (MV). Meta-analysis of seven randomized controlled trials revealed that remdesivir treatment reduced the need to initiate MV significantly compared to the control arms.
None
See this image and copyright information in PMC

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