Remdesivir for the treatment of patients hospitalized with COVID-19 receiving supplemental oxygen: a targeted literature review and meta-analysis

Abstract

This network meta-analysis (NMA) assessed the efficacy of remdesivir in hospitalized patients with COVID-19 requiring supplemental oxygen. Randomized controlled trials of hospitalized patients with COVID-19, where patients were receiving supplemental oxygen at baseline and at least one arm received treatment with remdesivir, were identified. Outcomes included mortality, recovery, and no longer requiring supplemental oxygen. NMAs were performed for low-flow oxygen (LFO2); high-flow oxygen (HFO2), including NIV; or oxygen at any flow (AnyO2) at early (day 14/15) and late (day 28/29) time points. Six studies were included (N=5,245 patients) in the NMA. Remdesivir lowered early and late mortality among AnyO2 patients (risk ratio (RR) 0.52, 95% credible interval (CrI) 0.34-0.79; RR 0.81, 95%CrI 0.69-0.95) and LFO2 patients (RR 0.21, 95%CI 0.09-0.46; RR 0.24, 95%CI 0.11-0.48); no improvement was observed among HFO2 patients. Improved early and late recovery was observed among LFO2 patients (RR 1.22, 95%CrI 1.09-1.38; RR 1.17, 95%CrI 1.09-1.28). Remdesivir also lowered the requirement for oxygen support among all patient subgroups. Among hospitalized patients with COVID-19 requiring supplemental oxygen at baseline, use of remdesivir compared to best supportive care is likely to improve the risk of mortality, recovery and need for oxygen support in AnyO2 and LFO2 patients.

Clinical evidence of the effectiveness of remdesivir in COVID-19 during periods dominated by Delta and Omicron SARS-CoV-2 variants.

“…Although the RDV-treated group was characterized by a lower percentage of patients requiring mechanical ventilation during both pandemic waves, the difference with a group not receiving any antiviral therapy was statistically insignificant. Nevertheless, the demonstration of a favorable trend in this regard is in line with reports by other authors 43,44 . Even the Solidarity trial, the initial results of which were the basis for not recommending RDV in the WHO guidelines, in the final report published in 2022 documented a significant beneficial effect on reducing mortality and disease progression requiring mechanical ventilation 45 .…”

An overview on the treatments and prevention against COVID-19

“…Based on obtained results, Remdesivir did not any significant difference in mortality rate in hospitalized adults with COVID-19; however, it can improve the percent recovered, decreases serious injuries, and probably leads to a decline in the rate of mechanical ventilation [ 19 – 21 ]. The National Institutes of Health guidelines later recommended that combining Remdesivir with anti-inflammatory drugs such as Tocilizumab, corticosteroids, and Baricitinib, can increase the benefit observed across all endpoints in patients with pneumonia and on oxygen support [ 22 – 24 ]. Recently have been indicated that early Remdesivir therapy in patients with active malignancies reduces 28-day in-hospital mortality by 80% [ 25 ].…”

Perspective: repurposed Drugs for COVID-19

“…The network meta-analysis involving six studies was performed to assess the efficacy of remdesivir in hospitalized patients with COVID-19 requiring supplemental oxygen. Among patients requiring supplemental oxygen at baseline, the use of remdesivir compared to best supportive care improved the risk of mortality, recovery, and need for oxygen support in patients receiving oxygen at any flow or low flow [18].…”