OBJECTIVES:

To evaluate the effectiveness (mortality, clinical improvement, discharge status, length of stay, and safety outcome (overall adverse effects) of remdesivir as a treatment for Covid-19 in adults.

METHODS:

A literature search was performed on PubMed, Embase, Cochrane library, and clinicaltrials.gov from December 2019 to June 2021. Studies comparing remdesivir to placebo, active comparator, or standard of care (SOC) for the treatment of Covid-19 in adults were included. The random-effects model was utilized to calculate the pooled risk ratio and 95% confidence intervals (CI) for randomized controlled trials (RCTs) and observational studies (OBS) separately.

RESULTS:

Seven studies were included, four RCTs, and three OBS. The overall pooled estimates suggested that remdesivir reduced the 15 and 28-day mortality in RCTs (RR 0.63, 95% CI 0.40, 0.97 at day 15 and RR 0.93, 95% CI 0.80, 1.07 at days 28) and OBS (RR 0.31, 95% CI 0.15, 0.62 at day 15 and RR 0.60, 95% CI 0.43, 0.83 at day 28). Compared to the control arm in the RCTs, more patients on remdesivir showed a statistically significant clinical improvement (RR 1.09, 95% CI 1.02,1.16) and had a higher rate of discharge at day 28 (RR 1.08, 95% CI 1.01, 1.15). No difference was found in mean length of stay (-1.7 days, 95% CI -3.93, 0.53) for RCTs and (-2.5 days, -4.55, 0.45) for OBS. While the overall adverse effects were not statistically significant in RCTs (RR 1.02, 95% CI 0.87, 1.20), these reached statistical significance in OBS (RR 0.50, 0.34, 0.74) favoring remdesivir compared to the control group.

CONCLUSIONS:

In the current meta-analyses, evidence showed effectiveness and safety in remdesivir in terms of mortality, clinical improvement, and discharge rate compared to the control group at day 28. Length of hospital stay in the remdesivir group was not different from the control group.