Real-world effectiveness of remdesivir for hospitalized patients with COVID-19: systematic review and metaanalysis

ABSTRACT

Introduction: Trials of remdesivir (RDV) for COVID-19 have provided evidence for regulatory approval. This is the first meta-analysis (MA) to evaluate the real-world effectiveness of RDV in patients hospitalized with COVID-19. Objective(s) To synthesize RDV observational data. Method(s) A systematic literature review identified observational studies of RDV. Outcomes were all-cause mortality and progression to invasive mechanical ventilation (IMV) assessed at early (day 14/15) and late (day 28/29/30) timepoints. MAs were conducted using standard random effects models;analyses were performed with R statistical software. Result(s) Of 1,069 studies identified, 29 met inclusion criteria for mortality data, 18 were excluded for low quality based on the ROBINS-I tool;11 studies from the United Kingdom, European Union, United States and Japan were included in the MA (N=166,399 patients). RDV was associated with a significant improvement in mortality at early (5 studies;risk ratio [RR] 0.71, 95% confidence interval [CI] 0.64-0.79) and late (10 studies, RR 0.82, 95%CI 0.71-0.95;Figure) timepoints. No significant effect was shown on the proportion of patients requiring IMV (evaluable only in the 3 studies denoted by asterisk in Figure, RR 1.07, 95%CI 0.84-1.34). Results were robust to scenario analyses. Conclusion(s) In a real-world setting, RDV is effective in reducing mortality in hospitalized COVID-19 patients.