Effects of remdesivir in patients hospitalised with COVID-19: a systematic review and individual patient data meta-analysis of randomised controlled trials

Remdesivir saves lives. Were 3 years needed to learn that?

“…In summary, this individual patient data meta-analysis 1 adds relevant scientific evidence and supports both the lower progression to mechanical ventilation and the significant survival benefits of remdesivir for patients hospitalised for COVID-19 with or without supplemental oxygen. The study suggests individualising approaches to remdesivir treatment for patients on mechanical ventilation, a practical example being continuing remdesivir in order to combat progressive respiratory failure due to persistent SARS-CoV-2 viral replication.…”

“…Notably, these results confirm the findings of ACTT-1 that were reported in April, 2020. 2 Additionally, it should not be surprising that if remdesivir significantly reduced mortality in patients receiving supplemental oxygen, 2 patients given remdesivir earlier in the course of COVID-19 should also benefit: such findings were shown by the Solidarity trial 7 and this meta-analysis 1 (significantly better survival and lower progression to mechanical ventilation or death in hospitalised patients with or without supplemental oxygen); by multiple large, real-world, comparative effectiveness studies from different countries 8 , 9 , 10 , 11 (significantly better survival and clinical recovery in hospitalised patients without supplemental oxygen); and by the PINETREE trial 12 (significantly lower progression to hospitalisation or death in outpatients at high risk without supplemental oxygen).…”

“…In The Lancet Respiratory Medicine , Alain Amstutz and colleagues 1 address a 3-year-old controversy: does remdesivir reduce mortality in patients hospitalised for COVID-19?…”

“…The individual patient data meta-analysis by Amstutz and colleagues 1 featured prespecified analyses according to group allocation, standardised outcome definitions, and adverse events stratified by organ systems. The study evaluated data from a total of 10 480 patients in eight randomised controlled trials and concluded that remdesivir significantly reduces mortality in patients hospitalised with COVID-19 with or without supplemental oxygen (adjusted odds ratio [aOR] 0·80 [95% CI 0·70–0·93]).…”

Epidemiology and outcomes of previously healthy critically ill patients with COVID-19: A population-based cohort

“…The factors underlying these contrasting findings cannot be determined from the administrative data set used in our study. They may, however, reflect the lack of effective antiviral therapy in critically ill patients with COVID-19 5,30 and uncertainties about the optimal management approach of COVID-19-related organ dysfunction 31 during the first year of the pandemic. Together, these management limitations may have been better tolerated overall by previously healthy people with COVID-19 who developed critical illness compared to their counterparts with comorbid conditions.…”