(132) Efficacy and safety of Remdesivir in COVID-19 patients: An overview of meta-Analysis

Publication Number: 469

Background: There is an ambiguity in the current evidence on the efficacy and safety of remdesivir in the management of coronavirus disease 2019 (COVID-19). To address this inconsistency, we conducted an overview of meta-analysis (MA) to guide clinical decision-making on the use of remdesivir in COVID-19 patients.

Objectives: We aimed to conduct an overview, critically appraise the available MA and perform an updated MA with the available primary studies.

Methods: We used the Preferred Reporting Items for Overviews of Systematic Reviews (PRIO-harms) guidelines and the protocol was registered in PROSPERO (CRD42022309976). Databases such as PubMed/Medline, Cochrane library, SCOPUS and Embase were searched from inception till December 2022. Meta-analyses assessing the efficacy and safety of remdesivir in COVID-19 patients were eligible for inclusion. Mortality; ventilation, oxygenation and ICU requirement; duration of hospitalization and rate of hospital discharge were the efficacy outcomes. The occurrence of adverse events were the safety outcomes. The methodological quality of included MA was assessed using AMSTAR-2. The primary studies (RCTs and Observational) with the above inclusion criteria were considered for the updated meta-analysis. Cochrane risk of bias tool and new castle Ottawa scale were used to assess the quality of included RCTs and observational studies, respectively.

Results: A total of 42 MA with a moderate to high quality were considered for the overview. Findings from overview showed a significantly better effect in clinical improvement (n=11) and recovery rate (n=12) in remdesivir treated patients when compared to control group. However, all the other outcomes were inconsistent. The updated MA with 24 primary studies (14 RCTs and 10 observational studies) reported a significant decrease in over-all mortality (OR:0.31;95%CI:0.37-0.74;I2:89%;n=18), serious adverse events (OR:0.75;95%CI:0.56-0.99;I2:72%;n=12) and grade 3-4 adverse events (OR:0.83;95%CI:0.71-0.98;I2:0%; n=5) in remdesivir treated patients when compared to the control group. The remaining efficacy and safety endpoints were non-significant. The quality of RCTs were high and moderate for observational studies.

Conclusions: Our overview suggests that, remdesivir was effective in increasing the clinical improvement and recovery rate in COVID-19 patients. The updated meta-analysis showed a significant mortality reduction with a better safety profile in remdesivir treated patients.