Efficacy and safety of remdesivir in COVID-19 caused by SARS-CoV-2: a systematic review and meta-analysis
Objectives Evaluation of remdesivir, an RNA polymerase inhibitor, for effectiveness in adults with COVID-19.Data sources Electronic search for eligible articles of PubMed, Cochrane Central and clinicaltrials.gov was performed on 20 September 2020.Participants and study eligibility criteria Only rand...
Main Authors: | , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMJ Publishing Group
2021-06-01
|
Series: | BMJ Open |
Online Access: | https://bmjopen.bmj.com/content/11/6/e048416.full |
id |
doaj-1b44c932631c4c3f87208921658f6df4 |
---|---|
record_format |
Article |
spelling |
doaj-1b44c932631c4c3f87208921658f6df42021-08-07T17:02:56ZengBMJ Publishing GroupBMJ Open2044-60552021-06-0111610.1136/bmjopen-2020-048416Efficacy and safety of remdesivir in COVID-19 caused by SARS-CoV-2: a systematic review and meta-analysisDaisy Khera0Ankita Chugh1Vinay Kumar Chugh2Pushpinder Singh Khera3Surjit Singh4Department of Pediatrics, All India Institute of Medical Sciences Jodphur, Jodhpur, IndiaDentistry, All India Institute of Medical Sciences Jodhpur, Jodhpur, India1 Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Jodhpur, India Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India2 Pharmacology, AIIMS Jodhpur, Jodhpur, India Objectives Evaluation of remdesivir, an RNA polymerase inhibitor, for effectiveness in adults with COVID-19.Data sources Electronic search for eligible articles of PubMed, Cochrane Central and clinicaltrials.gov was performed on 20 September 2020.Participants and study eligibility criteria Only randomised controlled trials (RCTs) evaluating efficacy of remdesivir in COVID-19 were included for meta-analysis.Interventions Remdesivir was compared with standard of care.Primary and secondary outcomes Primary outcome was mortality and secondary outcomes were time to clinical improvement and safety outcomes like serious adverse events, respiratory failure.Study appraisal and synthesis methods Data synthesis was done with Cochrane review manager 5 (RevMan) V.5.3. Cochrane risk of bias V.2.0 tool was used for methodological quality assessment. The GRADE pro GDT was applied for overall quality of evidence.Results 52 RCTs were screened and 4 studies were included in analysis, with total of 7324 patients. No mortality benefit was observed with remdesivir versus control group (OR=0.92 (95% CI 0.79 to 1.07), p=0.30, moderate quality evidence). Significantly higher rates of clinical improvement (OR=1.52 (95% CI 1.24 to 1.87), p<0.0001, low quality) and faster time to clinical improvement (HR=1.28 (95% CI 1.12 to 1.46), p=0.0002, very low quality) was observed with remdesivir versus control group. Significant decrease was found in the risk of serious adverse events (RR=0.75 (95% CI 0.62 to 0.90), p=0.0003, low quality); however, no difference was found in the risk of respiratory failure (RR=0.85 (95% CI 0.41 to 1.77), p=0.67, very low quality evidence) with remdesivir.Conclusions As per the evidence from current review, remdesivir has shown no mortality benefit (moderate quality evidence) in the treatment of COVID-19. From a cost–benefit perspective, it is our personal opinion that it should not be recommended for use, especially in low and lower middle income countries.Trial registration number PROSPERO registration number: CRD42020189517.https://bmjopen.bmj.com/content/11/6/e048416.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Daisy Khera Ankita Chugh Vinay Kumar Chugh Pushpinder Singh Khera Surjit Singh |
spellingShingle |
Daisy Khera Ankita Chugh Vinay Kumar Chugh Pushpinder Singh Khera Surjit Singh Efficacy and safety of remdesivir in COVID-19 caused by SARS-CoV-2: a systematic review and meta-analysis BMJ Open |
author_facet |
Daisy Khera Ankita Chugh Vinay Kumar Chugh Pushpinder Singh Khera Surjit Singh |
author_sort |
Daisy Khera |
title |
Efficacy and safety of remdesivir in COVID-19 caused by SARS-CoV-2: a systematic review and meta-analysis |
title_short |
Efficacy and safety of remdesivir in COVID-19 caused by SARS-CoV-2: a systematic review and meta-analysis |
title_full |
Efficacy and safety of remdesivir in COVID-19 caused by SARS-CoV-2: a systematic review and meta-analysis |
title_fullStr |
Efficacy and safety of remdesivir in COVID-19 caused by SARS-CoV-2: a systematic review and meta-analysis |
title_full_unstemmed |
Efficacy and safety of remdesivir in COVID-19 caused by SARS-CoV-2: a systematic review and meta-analysis |
title_sort |
efficacy and safety of remdesivir in covid-19 caused by sars-cov-2: a systematic review and meta-analysis |
publisher |
BMJ Publishing Group |
series |
BMJ Open |
issn |
2044-6055 |
publishDate |
2021-06-01 |
description |
Objectives Evaluation of remdesivir, an RNA polymerase inhibitor, for effectiveness in adults with COVID-19.Data sources Electronic search for eligible articles of PubMed, Cochrane Central and clinicaltrials.gov was performed on 20 September 2020.Participants and study eligibility criteria Only randomised controlled trials (RCTs) evaluating efficacy of remdesivir in COVID-19 were included for meta-analysis.Interventions Remdesivir was compared with standard of care.Primary and secondary outcomes Primary outcome was mortality and secondary outcomes were time to clinical improvement and safety outcomes like serious adverse events, respiratory failure.Study appraisal and synthesis methods Data synthesis was done with Cochrane review manager 5 (RevMan) V.5.3. Cochrane risk of bias V.2.0 tool was used for methodological quality assessment. The GRADE pro GDT was applied for overall quality of evidence.Results 52 RCTs were screened and 4 studies were included in analysis, with total of 7324 patients. No mortality benefit was observed with remdesivir versus control group (OR=0.92 (95% CI 0.79 to 1.07), p=0.30, moderate quality evidence). Significantly higher rates of clinical improvement (OR=1.52 (95% CI 1.24 to 1.87), p<0.0001, low quality) and faster time to clinical improvement (HR=1.28 (95% CI 1.12 to 1.46), p=0.0002, very low quality) was observed with remdesivir versus control group. Significant decrease was found in the risk of serious adverse events (RR=0.75 (95% CI 0.62 to 0.90), p=0.0003, low quality); however, no difference was found in the risk of respiratory failure (RR=0.85 (95% CI 0.41 to 1.77), p=0.67, very low quality evidence) with remdesivir.Conclusions As per the evidence from current review, remdesivir has shown no mortality benefit (moderate quality evidence) in the treatment of COVID-19. From a cost–benefit perspective, it is our personal opinion that it should not be recommended for use, especially in low and lower middle income countries.Trial registration number PROSPERO registration number: CRD42020189517. |
url |
https://bmjopen.bmj.com/content/11/6/e048416.full |
work_keys_str_mv |
AT daisykhera efficacyandsafetyofremdesivirincovid19causedbysarscov2asystematicreviewandmetaanalysis AT ankitachugh efficacyandsafetyofremdesivirincovid19causedbysarscov2asystematicreviewandmetaanalysis AT vinaykumarchugh efficacyandsafetyofremdesivirincovid19causedbysarscov2asystematicreviewandmetaanalysis AT pushpindersinghkhera efficacyandsafetyofremdesivirincovid19causedbysarscov2asystematicreviewandmetaanalysis AT surjitsingh efficacyandsafetyofremdesivirincovid19causedbysarscov2asystematicreviewandmetaanalysis |
_version_ |
1721216803031482368 |