tetano
Editor, Senior Moderator
Clin Microbiol Infect
. 2022 May 19;S1198-743X(22)00230-0.
doi: 10.1016/j.cmi.2022.04.018. Online ahead of print.
Remdesivir for the treatment of COVID-19: A systematic review and meta-analysis
Todd C Lee[SUP] 1 [/SUP], Srinivas Murthy[SUP] 2 [/SUP], Olivier Del Corpo[SUP] 3 [/SUP], Julien Senécal[SUP] 3 [/SUP], Guillaume Butler-Laporte[SUP] 4 [/SUP], Zahra N Sohani[SUP] 5 [/SUP], James M Brophy[SUP] 6 [/SUP], Emily G McDonald[SUP] 7 [/SUP]
Affiliations
Abstract
Background: The benefits of remdesivir in the treatment of hospitalized patients with Covid-19 remain debated with the National Institutes of Health and the World Health Organization providing contradictory recommendations for and against use.
Objectives: To evaluate the role of remdesivir for hospitalized inpatients as a function of oxygen requirements.
Data sources: Beginning with our prior systematic review, we searched MEDLINE using PubMed from January 15, 2021, through January 22, 2022.
Study eligibility criteria: Randomized controlled trials; all languages.
Participants: All hospitalized adults with Covid-19.
Interventions: Remdesivir, in comparison to either placebo, or standard of care.
Assessment of risk of bias: We used the ROB-2 criteria.
Methods of data synthesis: The primary outcome was mortality, stratified by oxygen use (none, supplemental oxygen without mechanical ventilation, and mechanical ventilation). We conducted a frequentist random effects meta-analysis on the risk ratio (RR) scale and, to contextualize the probabilistic benefits, we also performed a Bayesian random effects meta-analysis on the risk difference scale. A ≥1% absolute risk reduction was considered clinically important.
Results: We identified 8 randomized trials, totaling 9157 participants. The RR for mortality comparing remdesivir versus control was 0.71 (95% confidence interval [CI] 0.42-1.22) in the patients who did not require supplemental oxygen; 0.83 (95%CI 0.73-0.95) for nonventilated patients requiring oxygen; and 1.19 (95%CI 0.98-1.44) in the setting of mechanical ventilation. Using neutral priors, the probabilities that remdesivir reduces mortality were 74.7%, 96.9% and 8.9%, respectively. The probability that remdesivir reduced mortality by ≥1% was 88.1% for nonventilated patients requiring oxygen.
Conclusions: Based on this meta-analysis, there is a high probability that remdesivir reduces mortality for nonventilated patients with COVID-19 requiring supplemental oxygen therapy. Treatment guidelines should be re-evaluated.
Keywords: COVID-19; Coronavirus; Meta-analysis; Mortality; Remdesivir.
. 2022 May 19;S1198-743X(22)00230-0.
doi: 10.1016/j.cmi.2022.04.018. Online ahead of print.
Remdesivir for the treatment of COVID-19: A systematic review and meta-analysis
Todd C Lee[SUP] 1 [/SUP], Srinivas Murthy[SUP] 2 [/SUP], Olivier Del Corpo[SUP] 3 [/SUP], Julien Senécal[SUP] 3 [/SUP], Guillaume Butler-Laporte[SUP] 4 [/SUP], Zahra N Sohani[SUP] 5 [/SUP], James M Brophy[SUP] 6 [/SUP], Emily G McDonald[SUP] 7 [/SUP]
Affiliations
- PMID: 35598856
- DOI: 10.1016/j.cmi.2022.04.018
Abstract
Background: The benefits of remdesivir in the treatment of hospitalized patients with Covid-19 remain debated with the National Institutes of Health and the World Health Organization providing contradictory recommendations for and against use.
Objectives: To evaluate the role of remdesivir for hospitalized inpatients as a function of oxygen requirements.
Data sources: Beginning with our prior systematic review, we searched MEDLINE using PubMed from January 15, 2021, through January 22, 2022.
Study eligibility criteria: Randomized controlled trials; all languages.
Participants: All hospitalized adults with Covid-19.
Interventions: Remdesivir, in comparison to either placebo, or standard of care.
Assessment of risk of bias: We used the ROB-2 criteria.
Methods of data synthesis: The primary outcome was mortality, stratified by oxygen use (none, supplemental oxygen without mechanical ventilation, and mechanical ventilation). We conducted a frequentist random effects meta-analysis on the risk ratio (RR) scale and, to contextualize the probabilistic benefits, we also performed a Bayesian random effects meta-analysis on the risk difference scale. A ≥1% absolute risk reduction was considered clinically important.
Results: We identified 8 randomized trials, totaling 9157 participants. The RR for mortality comparing remdesivir versus control was 0.71 (95% confidence interval [CI] 0.42-1.22) in the patients who did not require supplemental oxygen; 0.83 (95%CI 0.73-0.95) for nonventilated patients requiring oxygen; and 1.19 (95%CI 0.98-1.44) in the setting of mechanical ventilation. Using neutral priors, the probabilities that remdesivir reduces mortality were 74.7%, 96.9% and 8.9%, respectively. The probability that remdesivir reduced mortality by ≥1% was 88.1% for nonventilated patients requiring oxygen.
Conclusions: Based on this meta-analysis, there is a high probability that remdesivir reduces mortality for nonventilated patients with COVID-19 requiring supplemental oxygen therapy. Treatment guidelines should be re-evaluated.
Keywords: COVID-19; Coronavirus; Meta-analysis; Mortality; Remdesivir.