Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Feb 28, 2021; 9(1): 74-87
Published online Feb 28, 2021. doi: 10.13105/wjma.v9.i1.74
Efficacy and safety outcomes with remdesivir in COVID-19 patients: A meta-analysis
Tejas Kamleshbhai Patel, Parvati B Patel, Manish Barvaliya, Vijayalaxmi, Hira Lal Bhalla
Tejas Kamleshbhai Patel, Vijayalaxmi, Hira Lal Bhalla, Department of Pharmacology, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur 273008, Uttar Pradesh, India
Parvati B Patel, Department of Pharmacology, GMERS Medical College, Gotri, Vadodara 390021, Gujarat, India
Manish Barvaliya, Department of Pharmacology, Government Medical College, Bhavnagar, Bhavnagar 364001, Gujarat, India
Author contributions: All authors designed the meta-analysis; Patel TK and Patel PB conducted the literature search; Patel TK and Barvaliya M extracted the data; Patel TK, Patel PB and Barvaliya M analyzed the data; all authors interpreted the data; Patel TK wrote the first draft and revised subsequent drafts with input from Patel PB, Barvaliya M, Vijayalaxmi, and Bhalla HL.
Conflict-of-interest statement: All authors declare having no conflicts of interest.
PRISMA 2009 Checklist statement: Study has been conducted as per the PRISMA 2009 checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tejas Kamleshbhai Patel, MD, Associate Professor, Department of Pharmacology, All India Institute of Medical Sciences, Gorakhpur, Kunraghat, Gorakhpur 273008, Uttar Pradesh, India. dr.tkp2006@yahoo.co.in
Received: November 12, 2020
Peer-review started: November 12, 2020
First decision: February 12, 2021
Revised: February 16, 2021
Accepted: February 25, 2021
Article in press: February 25, 2021
Published online: February 28, 2021
Processing time: 110 Days and 5.2 Hours
Abstract
BACKGROUND

Remdesivir is a broad-spectrum antiviral drug having in vitro activity against severe acute respiratory syndrome coronavirus 2 and is currently being used on a compassionate basis outside of clinical trials.

AIM

To analyze the efficacy and safety of remdesivir compared with other interventions in coronavirus disease 2019 (COVID-19) patients.

METHODS

We searched online databases to include randomized controlled trials evaluating the efficacy and safety of remdesivir compared with other interventions in COVID-19 patients. We summarized efficacy and safety data as risk ratios (RRs) with 95% confidence interval (CI) and used Mantel-Haenszel fixed or random-effect models. We estimated the number needed to treat (NNT) to cause one additional outcome. We used the GRADE approach to assess the quality of the evidence for all outcome parameters.

RESULTS

We included four randomized controlled trials. We observed no significant difference in mortality (RR: 0.83; 95%CI: 0.57–1.20; I2 = 59%) and rate of ventilation (RR: 0.69; 95%CI: 0.41-1.18; I2 = 77%) between remdesivir- and placebo-treated patients. Remdesivir showed higher rates of clinical recovery than placebo (RR: 1.10; 95%CI: 1.04–1.16; I2 = 0%; NNT: 14.3). We observed no difference in overall adverse events between remdesivir- and placebo-treated patients (RR: 1.05; 95%CI: 0.86–1.27; I2 = 77%). We observed less risk of serious adverse events (RR: 0.75; 95%CI: 0.63–0.89; I2 = 0%) in remdesivir- than placebo-treated patients. The GRADE approach suggested moderate quality of evidence for all efficacy and safety outcomes.

CONCLUSION

We observed limited clinical benefit of remdesivir over placebo in the treatment of COVID-19. Our findings could be biased because of the small number of trials.

Keywords: COVID-19; SARS-CoV-2; Antiviral; Pneumonia; Remdesivir; Meta-analysis; Systematic review

Core Tip: Remdesivir is an antiviral drug having in vitro and in vivo activity against severe acute respiratory syndrome coronavirus 2. United States Food and Drug Administration has granted emergency use authorization for its use in all hospitalized patients. The findings of this meta-analysis suggest remdesivir can enhance clinical recovery without having significant benefits on mortality outcomes. because of lack of any major safety concerns, its use is recommended in the absence of effective antiviral drugs against coronavirus disease 2019.