Randomized controlled trials of remdesivir in hospitalized coronavirus disease 2019 patients: A meta-analysis

Azza Sarfraz1; 2; Zouina Sarfraz2; 3; Marcos Sanchez-Gonzalez; Jack Michel; George Michel; Odalys Frontela; Jorge Posada; Jose Cardona; Eugenio Angueira

doi:10.4103/2452-2473.309139

Azza Sarfraz^1,2, Zouina Sarfraz^2,3, Marcos Sanchez-Gonzalez², Jack Michel², George Michel², Odalys Frontela², Jorge Posada², Jose Cardona², Eugenio Angueira²

¹Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
²Division of Research and Academic Affairs, Larkin Health System, South Miami, Florida, USA
³Department of Research and Publication, Fatima Jinnah Medical University, Lahore, Pakistan

Abstract

BACKGROUND: The first cases of the coronavirus disease 2019 (COVID-19) were reported in Wuhan, China. No antiviral treatment options are currently available with proven clinical efficacy. However, preliminary findings from phase III trials suggest that remdesivir is an effective and safe treatment option for COVID-19 patients with both moderate and severe disease.

OBJECTIVE: The aim of the present meta-analysis was to investigate whether remdesivir was effective for treating COVID-19 including reduced in-hospital adverse events, oxygen support, and mortality rates.

METHODS: According to the PRISMA reporting guidelines, a review was conducted from January 1, 2020, until August 25, 2020, with MeSH terms including COVID-19, COVID, coronavirus, SARS-CoV-2, remdesivir, adenosine nucleoside triphosphate analog, and Veklury using MEDLINE, Scopus, and CINAHL Plus. A modified Delphi process was utilized to include the studies and ensure that the objectives were addressed. Using dichotomous data for select values, the unadjusted odds ratios (ORs) were calculated applying Mantel–Haenszel random-effects method in Review Manager 5.4.

RESULTS: Randomized controlled trials pooled in 3013 participants with 46.3% (n = 1395) in the remdesivir group and 53.7% (n = 1618) in the placebo group. The placebo group had a higher risk of mortality as compared to the intervention group with significant OR (0.61) (95% confidence interval of 0.45–0.82; P = 0.001). There was minimal heterogeneity among the studies (I² = 0%).

CONCLUSIONS: Our findings suggest that remdesivir extends clinical benefits by reducing mortality, adverse events, and oxygen support in moderate to severely ill COVID-19 patients. Concerted efforts and further randomized placebo-controlled trials are warranted to examine the potency of antiviral drugs and immunopathological host responses contributing to the severity of COVID-19