Clinical efficacy and safety of remdesivir in patients with COVID-19: a systematic review and network meta-analysis of randomized controlled trials

Abstract

Abstract Objectives We performed a systematic review and network meta-analysis of randomized controlled trials (RCTs) to provide updated information regarding the clinical efficacy of remdesivir in treating coronavirus disease 2019 (COVID-19). Methods PubMed, Embase, Cochrane Library, clinical trial registries of ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched for relevant articles published up to 18 November 2020. Results Five RCTs, including 13\u200a544 patients, were included in this meta-analysis. Among them, 3839 and 391 patients were assigned to the 10\u2009day and 5\u2009day remdesivir regimens, respectively. Patients receiving 5\u2009day remdesivir therapy presented greater clinical improvement than those in the control group [OR\u200a=\u200a1.68 (95% CI 1.18–2.40)], with no significant difference observed between the 10\u2009day and placebo groups [OR\u200a=\u200a1.23 (95% CI 0.90–1.68)]. Patients receiving remdesivir revealed a greater likelihood of discharge [10\u2009day remdesivir versus control: OR\u200a=\u200a1.32 (95% CI 1.09–1.60); 5\u2009day remdesivir versus control: OR\u200a=\u200a1.73 (95% CI 1.28–2.35)] and recovery [10\u2009day remdesivir versus control: OR\u2009=\u20091.29 (95% CI 1.03–1.60); 5\u2009day remdesivir versus control: OR\u200a=\u200a1.80 (95% CI 1.31–2.48)] than those in the control group. In contrast, no mortality benefit was observed following remdesivir therapy. Furthermore, no significant association was observed between remdesivir treatment and an increased risk of adverse events. Conclusions Remdesivir can help improve the clinical outcome of hospitalized patients with COVID-19 and a 5\u2009day regimen, instead of a 10\u2009day regimen, may be sufficient for treatment. Moreover, remdesivir appears as tolerable as other comparators or placebo.