Current best evidence for clinical care (more info)
The coronavirus disease 2019 (COVID-19) pandemic has become a global health crisis. Considering the recent food and drug administration (FDA) approval of remdesivir as the first officially approved agent for COVID-19 treatment, we performed this systematic review and meta-analysis to evaluate the efficacy and safety of remdesivir administration in COVID-19 patients. A systematic literature search was done through MEDLINE, Google Scholar, Web of Science, Scopus, Science Direct, Cochrane Library, medRxiv, and bioRxiv from their inception to December 22nd, 2020. Five randomized controlled trials (RCTs) and five non-randomized studies of intervention (NRSI) were entered into the meta-analysis. The results showed that remdesivir administration was associated with a significant improvement in the 28-day recovery (RR = 1.09, 95%CI, 1.04-1.15), low flow oxygen support through days one to 14 (RR = 2.88, 95%CI, 1.80-4.60), and invasive mechanical ventilation or extracorporeal membrane oxygenation requirement through days 14-28 of the follow-up time (RR = 5.34, 95%CI, 2.37-12.05). The risk of experiencing serious adverse drug reactions (ADRs) was significantly lower (RR = 0.75, 95%CI, 0.63-0.90) in the remdesivir group than the comparison/control group. The pooled median difference of the time to clinical improvement was 2.99 (95%CI = 2.71-3.28), which did not remain significant during the sensitivity analysis. The clinical output comparison of the 5-day and 10-day remdesivir courses revealed that the 5-day regimen might provide similar benefits while causing fewer serious ADRs than 10-day. The current meta-analysis provided an updated evaluation of scientific evidence on the use of remdesivir in COVID-19 patients. Performing adequate well-designed RCTs are needed to show more accurate results.
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As a hospitalist, reviews such as this on key treatment options for COVID are always relevant. As of today (3/1/21), I don't see this study yet included in the Infectious Disease Society of America's COVID treatment guidelines, which is excellent and sort of a living, evolving document (last update on remdesivir section was 11/20). If this meta-analysis is reviewed by IDSA (and especially if it is cited), it will decrease the usefulness of this individual publication (as people will just look at the IDSA guidelines) but will validate and amplify its actual findings. Showing front-line providers the direct evidence is of course always important. In the particular case of COVID, however, I do think evidence around therapies is less actionable by the individual provider and there is a larger-than-usual valuation placed on guidelines. This is because: 1) the evidence base is evolving rapidly; 2) providers are dealing with enough uncertainty; and 3) much use of remdesivir is not individual provider discretion but is tied to institutional guidelines and protocols that tend to track with public health recommendations and national guidelines (such as the IDSA).
This review reiterates what is now commonly known/thought about remdesivir. The review is methodologically sound but does not provide any new insights.
This is the second meta-analysis of remdesivir trials. It seems to disagree somewhat with the first.
Not sure this is news.
This article is hard to read. I doubt clinicians would take the time to digest it. The headline seems to be that remdesivir results in less severe illness and quicker recovery than controls without changing mortality; however, the benefit seemed to be seen largely in the non-randomised trials. Amongst the RCTs, it`s hard to see any benefit for most of the outcomes assessed. Add in that few of the RCTs are placebo-controlled and one wonders whether all this effort is worth it.
Well done systematic review and meta-analysis of the current data on 5 or 10 days of remdesivir in Covid-19 infections.