Use of remdesivir in patients with COVID-19: a systematic review and meta-analysis

Abstract

Objective: Studies in the literature regarding the use of remdesivir to treat COVID-19 patients have shown conflicting results. This study sought to answer questions related to the use of remdesivir for the treatment of patients hospitalized with moderate to severe COVID-19. Methods: This was a systematic review and meta-analysis including phase 3 randomized clinical trials (RCTs) and observational cohort studies selected from various databases, comparing patients hospitalized with moderate to severe COVID-19 receiving remdesivir and controls. Results: A total of 207 studies were retrieved, 9 of which met the eligibility criteria and were included in the study. The meta-analysis using RCTs alone showed no statistically significant differences regarding mortality or use of mechanical ventilation/extracorporeal membrane oxygenation between remdesivir and control groups, and the quality of evidence was moderate and low, respectively. The use of remdesivir increased the recovery rate by 6% (95% CI, 3-9); p = 0.004) and the clinical improvement rate by 7% (95% CI, 1-14); p = 0.02). Additionally, no significant differences in mortality were found between remdesivir and control groups when the meta-analysis used observational cohort studies alone (risk difference = -0.01 (95% CI, -0.02 to 0.01; p = 0.32), the quality of evidence being moderate, and the risk of adverse events was 4% ([95% CI, -0.08 to 0.01]; p = 0.09). Conclusions: The use of remdesivir for the treatment of patients with moderate to severe COVID-19 had no significant impact on clinically important outcomes.

Bradycardia and Outcomes in COVID-19 Patients on Remdesivir: A Multicenter Retrospective Study

“…In our study, remdesivir was associated with an increased length of hospital stay but decreased odds of mechanical ventilation. Although some studies and meta-analyses suggested that remdesivir did not reduce all-cause mortality and the need for invasive mechanical ventilation [ 13 - 15 ], others, similar to our findings, showed that remdesivir was associated with a significantly reduced need for invasive mechanical ventilation or extracorporeal membrane oxygenation in COVID-19 patients [ 16 - 18 ]. Many studies agree that the use of remdesivir was associated with improved time to recovery and recovery rate, especially in non-mechanically ventilated patients [ 19 - 21 ].…”

Virus Infection and Systemic Inflammation: Lessons Learnt from COVID-19 and Beyond

“…Remdesivir is a nucleoside analog prodrug, which is metabolized intracellularly to an adenosine triphosphate (ATP) analog that inhibits the activity of the viral RNA polymerase (sold under the brand name Veklury, Gilead) [ 187 ]. Its function as a broad-spectrum viral RNA-dependent RNA polymerase (RdRp) inhibitor is well studied and it is effective against several positive and negative-sense RNA viruses including Ebola, hepatitis C virus, respiratory syncytial virus, as well as SARS-CoV-2 in vitro and in vivo [ 188 , 189 ]. In contrast, it only shows low antiviral activity against the segmented negative-sense RNA viruses IAV, Lassa Virus, and Crimean-Congo hemorrhagic fever virus, which is likely facilitated by differences in the structural architecture of the polymerase active sites which disfavors remdesivir as a substrate for RNA synthesis [ 190 , 191 , 192 ].…”

Evaluation of the efficacy and safety of remdesivir in hospitalized patients with a new coronavirus infection COVID-19: data from a Russian university clinic

“…Поскольку ингибирование фер-мента препятствует репликации вируса в инфицированных клетках, он проявляет антивирусную активность против ряда одноцепочечных РНК-содержащих вирусов, включая коронавирусы MERS и SARS [6,7]. Официальное разрешение для использования ремдесивира при лечении COVID-19 было выдано FDA (Управление по санитарному надзору за качеством пищевых продуктов и медикаментов США) 1 мая 2020 г. Недавний метаанализ показал, что использование ремдесивира способствовало увеличению частоты выздоровления на 6% (95% ДИ: 3-9, р = 0,004) и клинического улучшения на 7% (95% ДИ: 1-14, р = 0,02), однако не оказывало статистически значимого влияния на показатели смертности [8]. Эти результаты были подтверждены другим независимым метаанализом, не выявившим значения ремдесивира в рамках снижения летальности у госпитализированных пациентов с COVID-19 [9].…”