Safety and Efficacy of Remdesivir for the Treatment of COVID-19: A Systematic Review and Meta-Analysis

Abstract

Purpose: To evaluate the safety and efficacy of remdesivir in adult patients with COVID-19. Methods: PubMed, Embase, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov, and medRxiv databases were searched using a search strategy tailored to each database. The Consolidated Standards of Reporting Trials (CONSORT) and Strengthening the reporting of observational studies in epidemiology (STROBE) checklists were used for the studies' qualitative assessment. The outcomes studied were mortality, all adverse events, serious adverse events, and clinical improvement. The quantitative synthesis was conducted using fixed and random effects models in the CMA 2.2. Heterogeneity was tested using the I-squared (I2) measure. Results: In general, six studies, including five randomized controlled trials and one cohort study were found eligible. Comparison of the findings related to both groups receiving remdesivir (10-day remdesivir group) and placebo/control group showed that remdesivir treatment had no significant effect on mortality at day 14 of the treatment (RR=0.769; 95% CI :0.563-1.050; p=0.098), and all adverse events (RR= 1.078; 95% CI: 0.908-1.279; p= 0.392). However, remdesivir had a significant effect on clinical improvement at day 14 compared to placebo/control (OR= 1.447; 95% CI: 1.005-2.085; p= 0.047) and reduced serious adverse events (RR= 0.736; 95% CI: 0.611-0.887; p= 0.001). Conclusion: Remdesivir has positive effects on clinical improvement, and reduction of the risk of serious adverse events. However, it does not influence the mortality at day 14 of treatment.

Most published systematic reviews of remdesivir for COVID-19 were redundant and lacked currency

“…We included 36 reviews of remdesivir [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] plus two major living reviews of all treatments for COVID-19 [ 25 , 26 ] (collectively reported in 45 publications up to May 20, 2021). The first review was published on April 30, 2020 [42] , the day after the first randomized trial of remdesivir and the preliminary findings of two other trials were published.…”

Remdesivir for COVID‐19 pneumonia in patients with severe chronic kidney disease: A Case series and review of the literature

“…Although Remdesivir did not demonstrate mortality benefits, its efficacy in decreasing recovery time in moderate and severe COVID‐19 infection has been highlighted during large scale randomized clinical trials. 7 …”

Effectiveness of low-dose radiation therapy in COVID-19 patients globally: A systematic review

“…Remdesevir has shown an improved rate of clinical recovery in COVID-19 patients. 43 Studies regarding the toxicity of LDRT suggest that doses lower than 1 Gy may not majorly concern short-term or longterm follow-up. 39 The risk of radiation injury in medical imaging has been discussed in the past and hovers between 10 mSv to 100 mSv.…”