COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Treatment Lai CC, Chen CH, Wang CY, et al. Clinical efficacy and safety of remdesivir in patients with COVID-19: a systematic review and network meta-analysis of randomized controlled trials. J Antimicrob Chemother. 2021 Mar 24. pii: 6184581. doi: 10.1093/jac/dkab093.
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.

Ratings
Discipline / Specialty Area Score
Hospital Doctor/Hospitalists
Internal Medicine
Infectious Disease
Respirology/Pulmonology
Intensivist/Critical Care
Comments from MORE raters

Hospital Doctor/Hospitalists rater

This important study provides recent information with the largest number of patients. The results are solid, based on the analysis of randomized control trials with heterogeneity was low or absent across studies. There is relevant information about the possibility that remdesivir can help improve the clinical outcome of hospitalized patients with COVID-19 based on a 5 day regimen.

Infectious Disease rater

This is a meta-analysis of remdesivir in SARS-CoV-2 (COVID-19) infection. It concludes that 5- and 10-day regimens are more or less equal in efficacy and that the drug is well tolerated. The problem is that remdesivir's efficacy is dependent on the time it is started in the course of the disease, which is not discussed in this meta-analysis. So, although the conclusion may be true, it is difficult to translate it into clinical practice.

Infectious Disease rater

This is a network metanalysis of clinical trials of remdesivir in hospitalized patients with SARS CoV-2. The key finding is that 5 days Rx may provide same benefit as 10 day with fewer adverse effects and lower cost.

Intensivist/Critical Care rater

This meta-analysis is interesting since it suggests that a remdesivir therapy for 5 days is superior compared to a treatment duration of 10 days. However, in my opinion, these data do not yet support the clinical application of remdesivir in this way. Only 2 of 5 studies really compared 5 versus 10 days. One study did not prove a benefit and the other study was unsure whether the benefit was clinically relevant.

Respirology/Pulmonology rater

The metanalysis included 3 open label and 2 double blind trials. Five days equal or better than 10 days reduced costs; the was no improvement in mortality rate. We have to await next contradictions as they occur with this pandemic.