Remdesivir and systemic corticosteroids for the treatment of COVID-19: A Bayesian re-analysis.
Int J Infect Dis
; 104: 671-676, 2021 Mar.
Article
in English
| MEDLINE | ID: covidwho-1101290
ABSTRACT
BACKGROUND:
The global death toll from coronavirus disease 2019 (COVID-19) has exceeded 2 million, and treatments to decrease mortality are needed urgently.OBJECTIVES:
To examine the probabilities of a clinically meaningful reduction in mortality for remdesivir and systemic corticosteroids. DESIGN, SETTING ANDPARTICIPANTS:
This was a probabilistic re-analysis of clinical trial data for corticosteroids and remdesivir in the treatment of hospitalized patients with COVID-19 using a Bayesian random effects meta-analytic approach. Studies were identified from existing meta-analyses performed by the World Health Organization. MAIN OUTCOMES ANDMEASURES:
Posterior probabilities of an absolute decrease in mortality compared with control patients, by subgroups based on oxygen requirements, were calculated for corticosteroids and remdesivir. Probabilities of ≥1%, ≥2% and ≥5% absolute decrease in mortality were quantified.RESULTS:
For patients needing mechanical ventilation, the probability of ≥1% absolute decrease in mortality was 4% for remdesivir and 93% for corticosteroids. For patients needing supplemental oxygen without mechanical ventilation, the probability of ≥1% absolute decrease in mortality was 81% for remdesivir and 93% for dexamethasone. Finally, for patients who did not need oxygen support, the probability of ≥1% absolute decrease in mortality was 29% for remdesivir and 4% for dexamethasone. CONCLUSIONS AND RELEVANCE Using a Bayesian analytic approach, remdesivir had low probability of achieving a clinically meaningful reduction in mortality, except for patients needing supplemental oxygen without mechanical ventilation. Corticosteroids were more promising for patients needing oxygen support, especially mechanical ventilation. While awaiting more definitive studies, this probabilistic interpretation of the evidence will help to guide treatment decisions for clinicians, as well as guideline and policy makers.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Adenosine Monophosphate
/
Bayes Theorem
/
Adrenal Cortex Hormones
/
Alanine
/
SARS-CoV-2
/
COVID-19 Drug Treatment
Type of study:
Prognostic study
/
Randomized controlled trials
/
Reviews
Limits:
Humans
Language:
English
Journal:
Int J Infect Dis
Journal subject:
Communicable Diseases
Year:
2021
Document Type:
Article
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