BACKGROUND Remdesivir is a broad-spectrum antiviral drug having in vitro activity against severe acute respiratory syndrome coronavirus 2 and is currently being used on a compassionate basis outside of clinical trials...BACKGROUND Remdesivir is a broad-spectrum antiviral drug having in vitro activity against severe acute respiratory syndrome coronavirus 2 and is currently being used on a compassionate basis outside of clinical trials.AIM To analyze the efficacy and safety of remdesivir compared with other interventions in coronavirus disease 2019(COVID-19)patients.METHODS We searched online databases to include randomized controlled trials evaluating the efficacy and safety of remdesivir compared with other interventions in COVID-19 patients.We summarized efficacy and safety data as risk ratios(RRs)with 95%confidence interval(CI)and used Mantel-Haenszel fixed or randomeffect models.We estimated the number needed to treat(NNT)to cause one additional outcome.We used the GRADE approach to assess the quality of the evidence for all outcome parameters.RESULTS We included four randomized controlled trials.We observed no significant difference in mortality(RR:0.83;95%CI:0.57–1.20;I2=59%)and rate of ventilation(RR:0.69;95%CI:0.41-1.18;I2=77%)between remdesivir-and placebo-treated patients.Remdesivir showed higher rates of clinical recovery than placebo(RR:1.10;95%CI:1.04–1.16;I2=0%;NNT:14.3).We observed no difference in overall adverse events between remdesivir-and placebo-treated patients(RR:1.05;95%CI:0.86–1.27;I2=77%).We observed less risk of serious adverse events(RR:0.75;95%CI:0.63–0.89;I2=0%)in remdesivir-than placebo-treated patients.The GRADE approach suggested moderate quality of evidence for all efficacy and safety outcomes.CONCLUSION We observed limited clinical benefit of remdesivir over placebo in the treatment of COVID-19.Our findings could be biased because of the small number of trials.展开更多
文摘BACKGROUND Remdesivir is a broad-spectrum antiviral drug having in vitro activity against severe acute respiratory syndrome coronavirus 2 and is currently being used on a compassionate basis outside of clinical trials.AIM To analyze the efficacy and safety of remdesivir compared with other interventions in coronavirus disease 2019(COVID-19)patients.METHODS We searched online databases to include randomized controlled trials evaluating the efficacy and safety of remdesivir compared with other interventions in COVID-19 patients.We summarized efficacy and safety data as risk ratios(RRs)with 95%confidence interval(CI)and used Mantel-Haenszel fixed or randomeffect models.We estimated the number needed to treat(NNT)to cause one additional outcome.We used the GRADE approach to assess the quality of the evidence for all outcome parameters.RESULTS We included four randomized controlled trials.We observed no significant difference in mortality(RR:0.83;95%CI:0.57–1.20;I2=59%)and rate of ventilation(RR:0.69;95%CI:0.41-1.18;I2=77%)between remdesivir-and placebo-treated patients.Remdesivir showed higher rates of clinical recovery than placebo(RR:1.10;95%CI:1.04–1.16;I2=0%;NNT:14.3).We observed no difference in overall adverse events between remdesivir-and placebo-treated patients(RR:1.05;95%CI:0.86–1.27;I2=77%).We observed less risk of serious adverse events(RR:0.75;95%CI:0.63–0.89;I2=0%)in remdesivir-than placebo-treated patients.The GRADE approach suggested moderate quality of evidence for all efficacy and safety outcomes.CONCLUSION We observed limited clinical benefit of remdesivir over placebo in the treatment of COVID-19.Our findings could be biased because of the small number of trials.
