Mortality Benefit of Remdesivir in COVID-19: A Systematic Review and Meta-Analysis

Bansal, Vikas; Mahapure, Kiran S.; Bhurwal, Abhishek; Gupta, Ishita; Hassanain, Sahar; Makadia, Janaki; Madas, Nimisha; Armaly, Paige; Singh, Romil; Mehra, Ishita; O’Horo, John C.; Kashyap, Rahul

doi:10.3389/fmed.2020.606429

Cited by 52 publications

(47 citation statements)

References 37 publications

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“…Aiswarya, et al found early initiation of remdesivir (within 48 hours of hospital admission) to be associated with 5.5 days decrease in the mean duration of hospitalization 25 . These results are consonant with what has been reported in the general population 15 , 16 , 39 .…”

Section: Discussionsupporting

confidence: 92%

“…Anti-COVID-19 therapies such as hydroxychloroquine or ritonavir/lopinavir, are not used anymore, whereas pulse steroid therapy increases in consonance with the current scientific data 10 , 11 , 12 , 13 , 14 as well as remdesivir. Developed initially as a possible treatment for Ebola, remdesivir has shown promising results against SARS-CoV2 in reducing hospital stay and mortality 15 , 16 , 17 . However, a latter study has displayed no effect on hospitalized patients with COVID-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay 33 .…”

Section: Discussionmentioning

confidence: 99%

“…Treatment for COVID-19 has been a matter of debate during the pandemic spread, including both antiviral and anti-inflammatory drugs 11 , 12 , 13 , 14 , 15 , 16 , 17 . Remdesivir is a prodrug of an adenosine analog that has demonstrated antiviral activity against a broad range of RNA virus families, including coronaviruses.…”

Section: Introductionmentioning

confidence: 99%

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Use and Safety of Remdesivir in Kidney Transplant Recipients With COVID-19

Buxeda¹,

Arias-Cabrales²,

Pérez‐Sáez³

et al. 2021

Kidney International Reports

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Introduction Remdesivir has demonstrated antiviral activity against coronavirus, shortening the time to recovery in adults hospitalized with moderate/severe COVID-19. Severe adverse events such as acute kidney injury (AKI) have been reported. There is little available data on the use and safety of remdesivir in kidney transplant (KT) recipients. Methods We present a multicenter cohort study of 51 KT recipients with COVID-19 treated with remdesivir. Outcomes and safety were assessed. Results Mean age at diagnosis was 60 years, with a median time since KT of 4.5 years. Mean time since admission to remdesivir was 2 days. Twenty-eight patients (54.9%) required mechanical ventilation (19 non-invasive). Mortality was 18.9%, markedly higher if ≥65 years-old (45% vs. 3.2% in younger patients). AKI was present in 27.7% of patients, but in 50% of cases it was diagnosed before treatment. Remdesivir did not require discontinuation because of adverse events in any case. We did not find significant hepatoxicity or systemic symptoms resultant from the drug. Conclusions In our cohort of KT recipients, remdesivir was well tolerated and safe in terms of renal and hepatic toxicity, but randomized trials are needed to assess its efficacy.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Use and Safety of Remdesivir in Kidney Transplant Recipients With COVID-19

Buxeda¹,

Arias-Cabrales²,

Pérez‐Sáez³

et al. 2021

Kidney International Reports

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“…35 Nevertheless, in the multivariable analysis they performed, they did not account for the use for inpatient treatment agents that have been proven to modify outcomes in COVID-19 patients such as steroids, Remdesivir, and Tocilizumab. [36][37][38] IL-6 levels and Ddimer 39 , markers predictive of outcomes in COVID-19, were also not accounted for. As such, this increases the risk of a bias in their analysis of association between anticoagulation and clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

Combined Anticoagulant and antiplatelet therapy is associated with an improved outcome in hospitalized COVID-19 patients: a propensity matched cohort study

Matli

Chamoun

Fares

et al. 2021

Preprint

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Background: COVID-19 is a respiratory disease that results in a prothrombotic state manifesting as thrombotic, microthrombotic and thromboembolic events. As a result, several antithrombotic modalities have been implicated in the treatment of this disease. This study aimed to identify if therapeutic anticoagulation or concurrent use of antiplatelet and anticoagulants was associated with an improved outcome in this patient population. Methods: A retrospective observational cohort study of adult patients admitted to a single university hospital for COVID-19 infection was performed. The primary outcome was a composite of in-hospital mortality, ICU admission, or the need for mechanical ventilation. The secondary outcomes were each of the components of the primary outcome, in-hospital mortality, ICU admission, or the need for mechanical ventilation. Results: 242 patients were included in the study and divided into 4 subgroups: therapeutic anticoagulation (TAC), prophylactic anticoagulation + antiplatelet (PACAP), therapeutic anticoagulation + antiplatelet (TACAP), and prophylactic anticoagulation (PAC) which was the reference for comparison. Multivariable cox regression analysis and propensity matching were done and showed when compared to PAC, TACAP and TAC were associated with less in-hospital all cause mortality with an adjusted hazard ratio (aHR) of 0.113 (95% confidence interval (CI) 0.028-0.449) and 0.126 (95% CI, 0.028-0.528) respectively. The number needed to treat (NNT) in both subgroups was 11. Furthermore, PACAP was associated with a reduced risk of invasive mechanical ventilation with an aHR of 0.07 (95% CI, 0.014-0.351). However, the was no statistically significant difference in the occurrence of major or minor bleeds, ICU admission, or the composite outcome of in-hospital mortality, ICU admission or the need for mechanical ventilation. Conclusion: The use of combined anticoagulant and antiplatelet agents or therapeutic anticoagulation alone in hospitalized COVID-19 patients was associated with a better outcome in comparison to prophylactic anticoagulation alone without an increase in the risk of major and minor bleeds. Sufficiently powered randomized controlled trials are needed to further evaluate the safety and efficacy of combining antiplatelet and anticoagulants agents or using therapeutic anticoagulation in the management of patients with COVID-19 infection.

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“…This virus belongs to the Coronaviridae family which also includes the severe acute respiratory syndrome coronavirus-1 (SARS-CoV-1) and Middle East respiratory syndrome coronavirus (MERS-CoV). COVID-19 was declared as a pandemic by WHO on March 11th, 2020 [ 31 - 32 ]. Fever, myalgia, cough, dyspnea, and flu-like symptoms are the most frequent symptoms of COVID-19, which predominantly affects the respiratory system.…”

Section: Reviewmentioning

confidence: 99%

Vaccine Development Throughout History

Saleh¹,

Qamar²,

Tekin³

et al. 2021

Cureus

Self Cite

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The emergence of the coronavirus disease 2019 (COVID-19) pandemic has made us appreciate how important it is to quickly develop treatments and save lives. The race to develop a vaccine for this novel coronavirus began as soon as the pandemic emerged. Time was the only limiting factor. From the first vaccine developed in 1796 against smallpox to the latest COVID-19 vaccine, there have been several vaccines that have reduced the burden of disease, with the associated mortality and morbidity. Over the years we have seen many new advancements in organism isolation, cell culture, whole-genome sequencing, and recombinant nuclear techniques. These techniques have greatly facilitated the development of vaccines. Each vaccine has its own development story and there is much wisdom to be gained from learning about breakthroughs in vaccine development.

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Mortality Benefit of Remdesivir in COVID-19: A Systematic Review and Meta-Analysis

Cited by 52 publications

References 37 publications

Use and Safety of Remdesivir in Kidney Transplant Recipients With COVID-19

Use and Safety of Remdesivir in Kidney Transplant Recipients With COVID-19

Combined Anticoagulant and antiplatelet therapy is associated with an improved outcome in hospitalized COVID-19 patients: a propensity matched cohort study

Vaccine Development Throughout History

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