Does remdesivir reduce mortality in moderately ill hospitalized patients with COVID-19?

In a recent study posted to the medRxiv* pre-print server, a team of researchers performed a meta-analysis to investigate the use of remdesivir in the treatment of coronavirus disease 2019 (COVID-19).

Study: Remdesivir for the Treatment of COVID-19: An Updated Systematic Review and Meta-Analysis. Image Credit: ffikretow/Shutterstock

Introduction

The usage of remdesivir in treating COVID-19 patients was discouraged by the World Health Organization (WHO) in November 2020. However, the Infectious Diseases Society of America and the National Institutes of Health recommended remdesivir to treat COVID-19 patients who did not require mechanical ventilation. Globally, the use of remdesivir is still debatable, and its potential benefits may be underemployed in treating COVID-19.

About the study

The present meta-analysis aimed to analyze the effects of remdesivir in treating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients. Randomized controlled trials (RCTs) that compared remdesivir to placebo or standard of care were identified.

The outcome of all-cause mortality was classified according to the level of baseline oxygen support required by hospitalized COVID-19 patients. A frequentist and a Bayesian meta-analysis was conducted according to the level of oxygen support required. At the same time, the mortality benefit was quantified using the Bayesian meta-analysis on the risk difference scale.

Eight RCTs were reviewed in the meta-analysis. Adjustments were made in the trials to include 2148 COVID-19 patients who did not need oxygen support, 5974 patients who needed supplemental oxygen but not mechanical ventilation, and 1035 patients requiring mechanical ventilation. RCTs comparing remdesivir to placebo or standard of care were also included.

Results

The results showed that comparing remdesivir versus standard of care or placebo, the mortality rate in patients who required supplemental oxygen was significantly reduced. A mortality benefit was also noted in patients who needed oxygen without requiring critical care. However, the study also found that remdesivir worsened the condition of patients requiring mechanical ventilation while the benefit of the drug was scarce for patients not needing any supplemental oxygen. 

The mortality benefit of remdesivir for COVID-19 patients who did not require oxygen support was found to be 74.7%, while it was 96.9% for patients requiring oxygen and 8.9% for patients requiring mechanical ventilation. The study also observed a probability of 88.1% that remdesivir reduced the risk of mortality by more than 1% for patients who required oxygen but not mechanical ventilation.

Conclusion

The study results conclude that remdesivir reduced patient mortality by 97%, particularly for patients requiring oxygen but not critical care. Furthermore, a mortality benefit of 69% was observed in patients requiring no oxygen support, 92% in patients who required supplemental oxygen but did not need any mechanical ventilation, and only 7% in patients who required mechanical ventilation.

The researchers believe that the benefits of remdesivir for early nosocomial COVID-19 or non-hypoxemic COVID-19 patients could be investigated in future RCTs to understand the drug's scope further. Studies are also required to understand the effect of remdesivir on non-invasive ventilation or high flow nasal oxygen. Also, future RCTs for non-critically ill COVID-19-hospitalized patients could include remdesivir as an active treatment arm and be studied according to different oxygen requirements in COVID-19 patients.   

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.