Impact of remdesivir on 28 day mortality in hospitalized patients with COVID-19: February 2021 Meta-analysis

Abstract

Background: The COVID-19 pandemic has stimulated worldwide investigation into a myriad of potential therapeutic agents, including antivirals such as remdesivir. The first RCT reporting results on the impact of remdesivir on COVID-19 in a peer reviewed journal was the ACTT-1 trial published in November, 2020. The ACTT-1 trial showed more rapid clinical improvement and a reduced risk of 28-day mortality in patients who received remdesivir. This study is a meta-analysis of peer reviewed RCTs aims to estimate the association of remdesivir therapy compared to the usual care or placebo on all-cause mortality in hospitalized patients with COVID-19. Software based tools to accelerate the analysis process. Methods: Meta-analysis of peer reviewed RCTs comparing remdesivir to usual care or placebo. The protocol for this meta-analysis was registered and published in the PROSPERO database (CRD42021229985) on February 5, 2021. Results: Four English language RCTs were identified, including data from 7,333 hospitalized patients worldwide using remdesivir in COVID-19 positive patients. Meta-analysis of all identified RCTs showed no difference in survival in patients who received remdesivir therapy compared to usual care or placebo. The random effects meta-analysis has a summary odd ratio is 0.89 (95% CI 0.65-1.21, p = 0.30). Considerable variability in the severity of illness is noted with the rates of IMV at the time of randomization ranging from 0% to 27%. Conclusions: This meta-analysis of randomized controlled trials published in peer-reviewed literature by February 1, 2021 did not show reduced mortality in hospitalized patients with COVID-19 who received remdesivir. Further research is needed to clarify the role of remdesivir therapy in the management of COVID-19.

COVID-19: Unmasking Emerging SARS-CoV-2 Variants, Vaccines and Therapeutic Strategies

“…Yet, many clinicians remain skeptical of remdesivir's benefits. A recent meta-analysis study of randomized controlled trials demonstrates no statistically significant evidence of reduced mortality in hospitalized COVID-19 patients when treated with remdesivir [129]. On 19 November 2020, WHO recommended against using remdesivir.…”

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.…”

COVID-19: Unmasking Emerging SARS-CoV-2 Variants, Vaccines and Therapeutic Strategies

“…Yet many clinicians remain skeptical of remdesivir's benefits. A recent meta-analysis study of randomized controlled trials demonstrates no statistically significant evidence of reduced mortality in hospitalized COVID patients when treated with Remdesivir [121]. On Nov19 2020, WHO recommended against using remdesivir.…”