Efficacy and Safety of Remdesivir for the Treatment of Patients with COVID-19: A Systematic Review
Remdesivir was widely used in India during the peak of the COVID-19 pandemic, and several guidelines recommended it for hospitalized hypoxic adult and pediatric patients. However, well-designed studies reported inconsistent results, and many international guidelines changed their recommendations wit...
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| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2025-04-01
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| Series: | Current Medical Issues |
| Subjects: | |
| Online Access: | https://journals.lww.com/10.4103/cmi.cmi_142_24 |
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| Summary: | Remdesivir was widely used in India during the peak of the COVID-19 pandemic, and several guidelines recommended it for hospitalized hypoxic adult and pediatric patients. However, well-designed studies reported inconsistent results, and many international guidelines changed their recommendations with each emerging COVID-19 variant. This rapid review was done as part of living evidence synthesis (previous versions available in https://indicovidguidelines.org) to assess the effectiveness of various interventions in COVID-19 infection contextualizing to the current Indian context. We conducted a systematic review of randomized controlled trials (RCTs) evaluating remdesivir in COVID-19 infection (current to September 29, 2023). Two reviewers independently evaluated the eligibility of search results and extracted data for predefined outcomes. The risk of bias (RoB) was assessed using the Cochrane RoB v2.0 tool and meta-analysis using RevMan 5.4. We used hazard ratios for continuous outcomes, risk ratios (RRs) for dichotomous outcomes, and Grading of Recommendations, Assessment, Development, and Evaluation methodology to determine the certainty of evidence, which was then documented in the “ Table 2. summary of findings using GRADEpro Guideline Development Tool. In total, nine RCTs with 12,984 COVID-19 patients were included. Low certainty of evidence revealed that remdesivir when compared to standard care/placebo may reduce progression to noninvasive ventilation or high-flow nasal oxygen (RR = 0.70; 95% confidence interval [CI] = 0.51–0.98) but makes little to no difference on all-cause mortality at 28–30 days (RR = 0.92; 95% CI = 0.84–1.01) and progression to oxygen therapy (RR = 0.81; 95% CI = 0.54–1.22). The effect of remdesivir on progression to invasive mechanical ventilation (RR = 0.73; 95% CI = 0.51–1.06), adverse effects requiring interruption of therapy (RR = 1.18; 95% CI = 0.41–3.21), and hospitalization (RR = 0.14; 95% CI = 0.03–0.59) was unclear due to the very low certainty of evidence. This review suggests that remdesivir has an unclear benefit in the current context of COVID-19 variants which have a low propensity for severe disease, as well as widespread immunization in the country. |
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| ISSN: | 0973-4651 2666-4054 |