ABSTRACT
Background Remdesivir was considered to be a specific drug for Corona Virus Disease 2019. This systematic review aims to evaluate remdesivir monotherapy and combination therapy related clinical efficacy and risk. Research design and methods PubMed, Embase, SCIE, Cochrane Library, and American Clinical trial Center were searched up to 1 April 2022. We included randomized controlled trials (RCTs) comparing Remdesivir monotherapy with control drugs, or comparing different combination therapy. Results 11 RCTs and 32 observational studies were included in analysis. In the main outcome, remdesivir use reduced mortality in patients with severe COVID-19 and improve recovery in patients. In other clinical outcomes, remdesivir use was associated with improved clinical status. In safety outcomes, remdesivir use did not cause liver or kidney damage. Compared with remdesivir alone, remdesivir combined with other drugs-steroids, favipiravir, and convalescent plasma- had no effect on mortality. In addition, remdesivir combined with tocilizumab may increase mortality. Conclusion Results of the systematic review showed that remdesivir was positive in COVID-19, especially patients with severe COVID-19. The more effective treatment of COVID-19 with other drugs combined with remdesivir is urgent and challenging research. Trial registration number PROSPERO registration number: CRD42022322859.