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Summary: Remdesivir is an antiviral agent that has shown broad‐spectrum activity, including against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Clinical trials investigating the role of remdesivir in coronavirus disease 2019 (Covid‐19) reported conflicting results. This study aimed to systematically review the best available evidence and synthesize the results. Several electronic databases were searched for candidate studies up to 12 October 2020. Studies eligible for meta‐analysis were selected based on the inclusion criteria. Primary outcomes are the recovery and mortality rates, while secondary outcomes are the safety profile of remdesivir. The main effective measures are the rate ratio (RR) and rate difference (RD). Four clinical trials and one observational study were included. Remdesivir treatment for 10 days increased the recovery rate on day 14 by 50% among severe Covid‐19 patients (RR = 1.5, 95%CI = 1.33–1.7), while on day 28 it was increased by 14% among moderate and severe Covid‐19 patients (RR = 1.14, 95%CI = 1.06–1.22). Additionally, remdesivir decreased the mortality rate on day 14 by 36% among all patients (RR = 0.64, 95%CI = 0.45–0.92) but not on day 28 (RR = 1.05, 95%CI = 0.56–1.97). Nonmechanically ventilated Covid‐19 patients showed better response to remdesivir in the recovery (RR = 0.3, 95%CI = 0.13–0.7) and mortality (RR = 2.33, 95%CI = 1.24–4.4) rates on day 14. Remdesivir reduced serious adverse effects by absolute 6% and no significant Grade 3 or 4 adverse effects were reported. At this early stage of the pandemic, there is evidence that remdesivir can be safely administered for hospitalized Covid‐19 patients. It improves the recovery rate in both moderate and severe patients but, the optimal effect is achieved for those who are severely affected but not mechanically ventilated. [ABSTRACT FROM AUTHOR]

Being a pandemic and having a high global case fatality rate directed us to assess the evidence strength of hydroxychloroquine efficacy in treating coronavirus disease‐2019 (COVID‐19) arising from clinical trials and to update the practice with the most reliable clinical evidence. A comprehensive search was started in June up to 18 July, 2020 in many databases, including PubMed, Embase, and others. Of 432 studies found, only six studies fulfilled the inclusion criteria, which includes: clinical trials, age more than 12 years with nonsevere COVID‐19, polymerase chain reaction‐confirmed COVID‐19, hydroxychloroquine is the intervention beyond the usual care. Data extraction and bias risk assessment were done by two independent authors. Both fixed‐effect and random‐effect models were utilized for pooling data using risk difference as a summary measure. The primary outcomes are clinical and radiological COVID‐19 progression, severe acute respiratory syndrome coronavirus‐2 clearance in the pharyngeal swab, and mortality. The secondary outcomes are the adverse effects of hydroxychloroquine. Among 609 COVID‐19 confirmed patients obtained from pooling six studies, 294 patients received hydroxychloroquine and 315 patients served as a control. Hydroxychloroquine significantly prevents early radiological progression relative to control with risk difference and 95% confidence interval of −0.2 (−0.36 to −0.03). On the other hand, hydroxychloroquine did not prevent clinical COVID‐19 progression, reduce 5‐day mortality, or enhance viral clearance on days 5, 6, and 7. Moreover, many adverse effects were reported with hydroxychloroquine therapy. Failure of hydroxychloroquine to show viral clearance or clinical benefits with additional adverse effects outweigh its protective effect from radiological progression in nonsevere COVID‐19 patients. Benefit‐risk balance should determine the hydroxychloroquine use in COVID‐19. Highlights: Hydroxychloroquine does not reduce mortality or save COVID‐19 patients live.Hydroxychloroquine does not promote a clinical improvement of SARS CoV‐2 infected patients.Hydroxychloroquine Fails to accelerate clearance of new coronavirus.Hydroxychloroquine increases adverse events specially diarrhea without proven clinical benefits.Meta‐analysis of clinical trials failed to show clear evidence, large randomized trial is required. [ABSTRACT FROM AUTHOR]