Efficacy and safety of remdesivir in COVID-19 caused by SARS-CoV-2: a systematic review and meta-analysis

Abstract

ObjectivesEvaluation of remdesivir, an RNA polymerase inhibitor, for effectiveness in adults with COVID-19.Data sourcesElectronic search for eligible articles of PubMed, Cochrane Central and clinicaltrials.gov was performed on 20 September 2020.Participants and study eligibility criteriaOnly randomised controlled trials (RCTs) evaluating efficacy of remdesivir in COVID-19 were included for meta-analysis.InterventionsRemdesivir was compared with standard of care.Primary and secondary outcomesPrimary outcome was mortality and secondary outcomes were time to clinical improvement and safety outcomes like serious adverse events, respiratory failure.Study appraisal and synthesis methodsData synthesis was done with Cochrane review manager 5 (RevMan) V.5.3. Cochrane risk of bias V.2.0 tool was used for methodological quality assessment. The GRADE pro GDT was applied for overall quality of evidence.Results52 RCTs were screened and 4 studies were included in analysis, with total of 7324 patients. No mortality benefit was observed with remdesivir versus control group (OR=0.92 (95% CI 0.79 to 1.07), p=0.30, moderate quality evidence). Significantly higher rates of clinical improvement (OR=1.52 (95% CI 1.24 to 1.87), p<0.0001, low quality) and faster time to clinical improvement (HR=1.28 (95% CI 1.12 to 1.46), p=0.0002, very low quality) was observed with remdesivir versus control group. Significant decrease was found in the risk of serious adverse events (RR=0.75 (95% CI 0.62 to 0.90), p=0.0003, low quality); however, no difference was found in the risk of respiratory failure (RR=0.85 (95% CI 0.41 to 1.77), p=0.67, very low quality evidence) with remdesivir.ConclusionsAs per the evidence from current review, remdesivir has shown no mortality benefit (moderate quality evidence) in the treatment of COVID-19. From a cost–benefit perspective, it is our personal opinion that it should not be recommended for use, especially in low and lower middle income countries.Trial registration numberPROSPERO registration number: CRD42020189517.

Effectiveness of Remdesivir, Lopinavir/Ritonavir, and Favipiravir for COVID-19 Treatment: A Systematic Review

“…30 It was also affirmed that remdesivir is currently prescribed as one of the main treatments for COVID-19 in about 50 countries, 31 and the maximum recommended daily dose is approximately 250 mg/kg of solvent used to dissolve the drug. 32 The previous review stated that remdesivir is favorable in patients with severe COVID-19 compared to placebo, although the safety data on the use of remdesivir is currently sparse. 33 The systematic review and network meta-analysis conducted by Lai et al also showed that remdesivir helps to improve clinical outcomes of hospitalized patients and demonstrates a promising role in treating patients with COVID-19.…”

“… 30 It was also affirmed that remdesivir is currently prescribed as one of the main treatments for COVID-19 in about 50 countries, 31 and the maximum recommended daily dose is approximately 250 mg/kg of solvent used to dissolve the drug. 32 …”

Computational Study of the Therapeutic Potential of Novel Heterocyclic Derivatives against SARS-CoV-2

“…Some of the strategies being used to control the viral spread of the disease are the recommended use of face masks, hand gloves, and sanitizers. While quite a number of vaccines are being developed to stimulate the production of antibodies against the virus, there are still concurrent investigations exploring the therapeutic potential of some anti-viral agents, including remdesivir [52,53]. As the search for new anti-SARS-CoV-2 drugs continues, the use of heterocyclic organic compounds in anti-viral drug development is essential as they have been reported to be efficacious against other major viral infections [31,54,55].…”

COVID-19 Advanced Care

“…An updated meta-analysis of existing trials, including ACTT1, SOLIDARITY and other additional trials performed by the SOLIDARITY group, also demonstrated no mortality benefit of remdesivir (RR 0.91, 95% CI 0.79-1.05) [13]. Interestingly, the results of an ACTT2 study suggest that if remdesivir is given in combination with the Janus kinase-inhibitor baricitinib, significant decreases in time to recovery are observed in hospitalized patients with SARS-CoV-2 [14].…”