Remdesivir: A potential game-changer or just a myth? A Systematic Review
and Meta-analysis
Abstract
Aim COVID-19 outbreak spread all over the world and created a public
health catastrophe. Here, we have aimed to conduct a systematic review
and meta-analysis on remdesivir use for COVID-19. Methods We searched
Pubmed, Pubmed Central, Scopus, Embase, clinicaltrials.gov, and preprint
sites and identified ten studies for qualitative and four studies for
quantitative analysis using PRISMA guidelines. The quantitative
synthesis was performed using fixed and random effect models in RevMan
5.4. Heterogeneity was assessed using the I-squared (I2) test. Results
Comparing remdesivir group with placebo or standard of care (SOC) group,
remdesivir reduces 14 days mortality (OR 0.61, CI 0.41- 0.91), need of
mechanical ventilation (OR 0.73, CI 0.54-0.97), and overall severe
adverse effects (OR 0.69, 95% CI 0.54 to 0.88). There is better
clinical improvement on day 28 (OR 1.59, CI 1.06- 2.39); day 14 clinical
recovery (OR 1.48, CI 1.19-1.84); day 14 discharge rate (OR 1.41, CI
1.15-1.73) among remdesivir groups. Earlier clinical improvement (MD
-2.51, CI -4.16 to -0.85); and clinical recovery (MD -4.69, CI -5.11 to
-4.28) seen among remdesivir group. While no difference on 28 days
mortality rate; discharge rate; overall adverse effect. Longer course
(10 days) of remdesivir showed higher discharge rate at day 14 (OR 2.11,
CI 1.50-2.97), but there are significantly higher rates of serious
adverse effects, and drug discontinuation than the shorter course.
Conclusion Remdesivir showed a better 14 days mortality profile,
clinical recovery, and discharge rate. Overall clinical improvement and
clinical recovery were earlier among remdesivir group.