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Review
. 2022 Feb;50(1):27-41.
doi: 10.1007/s15010-021-01671-0. Epub 2021 Jul 31.

Efficacy and safety of remdesivir in hospitalised COVID-19 patients: a systematic review and meta-analysis

Mulugeta T Angamo  1 , Mohammed A Mohammed  2 , Gregory M Peterson  3
Affiliations
Review

Efficacy and safety of remdesivir in hospitalised COVID-19 patients: a systematic review and meta-analysis

Mulugeta T Angamo et al. Infection. 2022 Feb.

Abstract

Purpose: This review was aimed to synthesise the best available evidence on the effectiveness and safety of remdesivir in the treatment of moderate to severe COVID-19.

Method: Randomised controlled trials (RCTs) and observational studies reporting the effectiveness and safety of remdesivir were searched via databases and other sources from December 2019 to December 2020. Two independent reviewers performed literature screening, data extraction and assessment of risk bias. Seven studies involving 3686 patients were included.

Results: Treatment with remdesivir was associated with an increase in clinical recovery rate by 21% (RR 1.21; 95% CI 1.08-1.35) on day 7 and 29% (RR 1.29; 95% CI 1.22-1.37) on day 14. The likelihoods of requiring high-flow supplemental oxygen and invasive mechanical ventilation in the remdesivir group were lower than in the placebo group by 27% (RR 0.73; 95% CI 0.54-0.99) and 47% (RR 0.53; 95% CI 0.39-0.72), respectively. Remdesivir-treated patients showed a 39% (RR 0.61; 95% CI 0.46-0.79) reduction in the risk of mortality on day 14 compared to the control group; however, there was no significant difference on day 28. Serious adverse effects (SAEs) were significantly less common in patients treated with remdesivir, with an absolute risk difference of 6% (RD -0.06; 95% CI -0.09 to -0.03).

Conclusion: Despite conditional recommendation against its use, remdesivir could still be effective in early clinical improvement; reduction of early mortality and avoiding high-flow supplemental oxygen and invasive mechanical ventilation among hospitalised COVID-19 patients. Remdesivir was also well tolerated without significant SAEs compared to placebo, yet available evidence from clinical studies support the need to conduct close monitoring.

Keywords: Coronavirus deisease-19; Effectiveness; Remdesivir; Safety.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of the included studies
Fig. 2
Fig. 2
Forest plot of clinical recovery rates on day 7, 14 and 28
Fig. 3
Fig. 3
Forest plot of the requirement of supplemental oxygen and ventilation
Fig. 4
Fig. 4
Forest plot of all-cause mortality on day 14 and 28
Fig. 5
Fig. 5
Forest plot of median time to recovery and discharge
Fig. 6
Fig. 6
Forest plot of safety outcomes of remdesivir
See this image and copyright information in PMC

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