1. Remdesivir for the treatment of COVID-19: a systematic review and meta-analysis.
- Author
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Lee TC, Murthy S, Del Corpo O, Senécal J, Butler-Laporte G, Sohani ZN, Brophy JM, and McDonald EG
- Subjects
- Adenosine Monophosphate analogs & derivatives, Adult, Alanine analogs & derivatives, Bayes Theorem, Humans, Oxygen, SARS-CoV-2, United States, COVID-19 Drug Treatment
- 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 15 January 2021 through 5 May 2022., Study Eligibility Criteria: Randomised 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 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 eight randomized trials, totaling 10 751 participants. The risk ratio for mortality comparing remdesivir vs. control was 0.77 (95% CI, 0.5-1.19) in the patients who did not require supplemental oxygen; 0.89 (95% CI, 0.79-0.99) for nonventilated patients requiring oxygen; and 1.08 (95% CI, 0.88-1.31) in the setting of mechanical ventilation. Using neutral priors, the probabilities that remdesivir reduces mortality were 76.8%, 93.8%, and 14.7%, respectively. The probability that remdesivir reduced mortality by ≥ 1% was 77.4% 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., (Copyright © 2022 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2022
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