Abstract
Importance/Background: During current public health emergency of COVID-19 pandemic, repurposing of existing antiviral drugs may be an efficient strategy since there is no proven effective treatment. Published literature shows Remdesivir has broad-spectrum antiviral activity against numerous RNA viruses and has been recently recognized as a promising therapy against SARS-CoV-2.Methods: A systematic search was conducted for full length manuscripts published between inception and July 19th, 2020 focussing on efficacy and safety of Remdesivir in COVID-19. The primary outcomes were defined as mortality rate and median days to recovery based on the available pooled data. The secondary outcome was adverse events rate and drug discontinuation rate.Statistical Analysis: All outcomes were performed using Comprehensive Meta-Analysis software package (Bio stat, Englewood, NJ, USA).Results: A total of 1,895 patients from 9 studies were included in this qualitative synthesis. In patients treated with Remdesivir, the mean recovery time was 15.84 days (95% CI 11.68–20, SE 2.12; I2 = 97.24) and the pooled mortality rate was 11.3% (95% CI 7.9–16%; I2 = 74.85). However, treatment with Remdesivir was associated with adverse effects (55.3%, 95% CI 31.5–76.9%; I2 = 97.66) eventually warranting the discontinuation of the drug (17.8%, 95% CI 8.6–33.1%; I2 = 95.64). The meta-analysis of three clinical trials indicated that administration of Remdesivir significantly reduces the mortality compared to the placebo (OR 0.70, 95% CI 0.58–0.84, p ≤ 0.001; I2 = 16.6).Conclusions and Relevance: The result of contemporary meta-analysis suggests mortality benefit with Remdesivir in COVID-19 and median recovery time was over 2 weeks. The pooled mortality with Remdesivir was found to be very low, and this analysis can shed light on this potential treatment for COVID-19 patients.
Highlights
The city of Wuhan in China initially noted and reported the first case of coronavirus, termed as SARS-CoV-2, in December 2019 [1]
A systematic search was conducted from COVID19 inception through July 19th, 2020, for full-length articles focusing on the efficacy and safety of Remdesivir in COVID-19
The search strategy consisted of keywords “Remdesivir,” “SARSCoV-2,” and “COVID-19” across the COVID 19 database provided by World Health Organization (WHO) Global Research Database, CDC COVID19 Research Articles Downloadable Database, and LitCovid database
Summary
The city of Wuhan in China initially noted and reported the first case of coronavirus, termed as SARS-CoV-2, in December 2019 [1]. The World Health Organization (WHO) confirmed the coronavirus outbreak as a worldwide public health emergency on January 30th, 2020, and a pandemic on March 11th, 2020 [2]. The 2019–2020 pandemic has infected more than 12 million people [4] This has resulted in more than 550,000 fatalities and correspond to a crude case mortality rate of ∼4.57% [4, 5]. In current medical and public health emergency, the rapid detection of effective treatment option against SARS-CoV-2 remains challenge. Remdesivir, an antiviral drug, has been recently recognized as a potential therapy against SARS-CoV-2 [6, 7]. On May 1st, 2020, the U.S Food and Drug Administration allowed the emergency use of Remdesivir for the management of COVID-19 in critically ill hospitalized patients [9]
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