Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Feb 28, 2021; 9(1): 74-87
Published online Feb 28, 2021. doi: 10.13105/wjma.v9.i1.74
Efficacy and safety outcomes with remdesivir in COVID-19 patients: A meta-analysis
Tejas Kamleshbhai Patel, Parvati B Patel, Manish Barvaliya, Vijayalaxmi, Hira Lal Bhalla
Tejas Kamleshbhai Patel, Vijayalaxmi, Hira Lal Bhalla, Department of Pharmacology, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur 273008, Uttar Pradesh, India
Parvati B Patel, Department of Pharmacology, GMERS Medical College, Gotri, Vadodara 390021, Gujarat, India
Manish Barvaliya, Department of Pharmacology, Government Medical College, Bhavnagar, Bhavnagar 364001, Gujarat, India
Author contributions: All authors designed the meta-analysis; Patel TK and Patel PB conducted the literature search; Patel TK and Barvaliya M extracted the data; Patel TK, Patel PB and Barvaliya M analyzed the data; all authors interpreted the data; Patel TK wrote the first draft and revised subsequent drafts with input from Patel PB, Barvaliya M, Vijayalaxmi, and Bhalla HL.
Conflict-of-interest statement: All authors declare having no conflicts of interest.
PRISMA 2009 Checklist statement: Study has been conducted as per the PRISMA 2009 checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tejas Kamleshbhai Patel, MD, Associate Professor, Department of Pharmacology, All India Institute of Medical Sciences, Gorakhpur, Kunraghat, Gorakhpur 273008, Uttar Pradesh, India. dr.tkp2006@yahoo.co.in
Received: November 12, 2020
Peer-review started: November 12, 2020
First decision: February 12, 2021
Revised: February 16, 2021
Accepted: February 25, 2021
Article in press: February 25, 2021
Published online: February 28, 2021
Processing time: 110 Days and 5.2 Hours
ARTICLE HIGHLIGHTS
Research background

There are no specific antiviral drugs currently available to combat coronavirus disease 2019 (COVID-19) caused by novel virus severe acute respiratory syndrome coronavirus 2. This has promoted the evaluation of various previously approved drugs as an effective treatment for COVID-19. Remdesivir is one such repurposed drug currently under investigation against COVID-19.

Research motivation

This study investigated whether remdesivir is an effective and safe option to treat COVID-19 patients.

Research objectives

In this study, the authors aimed to provide a meta-analytic summary of the efficacy and safety outcomes in COVID-19 patients with the use of remdesivir as compared with control interventions.

Research methods

A literature search was conducted to identify studies published through October 28, 2020. Randomized controlled trials of remdesivir plus any other interventions including placebo were included. The quality assessment of all included studies for methodological characteristics was performed with the revised Cochrane risk of bias assessment tool for randomized controlled clinical trials. The efficacy outcome variables were mortality, need for mechanical ventilation, composite mortality and ventilation and clinical recovery rate. The safety outcome variables were overall adverse events, grade 3 or 4 adverse events and the serious adverse events rate.

Research results

We included a total of four randomized controlled trials in this meta-analysis. Three studies were considered to have a low risk and one study was considered to have some concerns in the overall risk of bias assessment. Remdesivir- and placebo-treated patients did not differ in mortality, rate of mechanical ventilation and composite mortality and ventilation rate outcomes. A sensitivity analysis suggested a reduced risk of ventilation and composite mortality and ventilation with remdesivir on exclusion of open-label studies. Remdesivir-treated patients showed higher rates of clinical recovery than placebo-treated patients. Remdesivir and placebo-treated patients did not differ in the overall occurrence of adverse events. Remdesivir-treated patients were at lower risk of grade 3 or 4 adverse events and serious adverse events than placebo-treated patients. The GRADE approach suggested moderate quality of evidence for all efficacy and safety outcomes.

Research conclusions

The effect of remdesivir over placebo was not significant for mortality or the rate of ventilation. However, remdesivir may provide higher rates of clinical cure. There are no major safety concerns with the use of remdesivir. Its use can be continued on a compassionate basis in the absence of specific antiviral drugs.

Research perspectives

The current evidence is based on four clinical trials only. More evidence based on double-blind randomized controlled trials in different disease-severity populations is required to evaluate the benefits of remdesivir in COVID-19 patients.