In patients with acute COVID-19, should remdesivir be used compared to placebo?
Authors: J Ramos , F Novillo , D Nava , C Ávila , AM Rojas , V Veloso , G Rada , F Verdugo-Paiva 
Published: September 2023

Objective
The aim of this living systematic review is to provide a summary of the effects of remdesivir in the of people with acute covid-19.
Methods
Eligible studies were randomised trials evaluating the effect of remdesivir versus placebo or no treatment. We conducted searches in COVID-19 L·OVE (Living OVerview of Evidence) platform, a system that performs regular searches in databases, trial registries, preprint servers and websites relevant to COVID-19. All the searches covered the period until 06/23/2023. No date or language restrictions were applied.
Two reviewers independently evaluated potentially eligible studies according to predefined selection criteria, and extracted data on study characteristics, methods, outcomes, and risk of bias, using a predesigned, standardised form.
We performed meta-analyses using random-effect models and assessed overall certainty in evidence using the GRADE approach.
Results
Our search strategy yielded 897 references. 10 randomized controlled trials reported in 15 references met our inclusion criteria and were
included in the review.
The relative risk of mortality was 0.91 (95% CI 0.83 - 1.00). This means remdesivir reduced the risk of mortality in 9%, compared with placebo or no treatment. In the studies identified in this review 760 people not receiving remdesivir out of 5372 presented the outcome Mortality (141 per 1000) versus 732 out of 5790 in the group that did receive it, with a risk difference of -12.22 per 1000 (from -24 to 0). In other words, -12.22 per 1000 (from -24 to 0) people did not develop the outcome because of the intervention. We assessed the certainty of the evidence for this outcome as low. The estimated absolute effect, -12.22 per 1000 (from -24 to 0), falls in the range of an effect of small magnitude.
The relative risk of mechanical ventilation requirement was 0.62 (95% CI 0.40 - 0.94). This means placebo or no treatment reduced the risk of mechanical ventilation requirement by 38%, compared with . In the studies identified in this review 710 people not receiving placebo or no treatment out of 4539 presented the outcome Mechanical ventilation requirement (156 per 1000) versus 616 out of 4920 in the group that did receive it, with a risk difference of -60.11 per 1000 (from -93 to -10). In other words, -60.11 per 1000 (from -93 to -10) people did not develop the outcome because of the intervention. We assessed the certainty of the evidence for this outcome as low. The estimated absolute effect, -60.11 per 1000 (from -93 to -10), falls in the range of an effect of moderate magnitude.
The relative risk of serious adverse events was 0.75 (95% CI 0.60 - 0.92). This means reduced the risk of serious adverse events by 25%, compared with . In the studies identified in this review 266 people not receiving out of 1266 presented the outcome Serious adverse events (210 per 1000) versus 266 out of 1665 in the group that did receive it, with a risk difference of -53.38 per 1000 (from -84 to -16). In other words, -53.38 per 1000 (from -84 to -16) people did not develop the outcome because of the intervention. We assessed the certainty of the evidence for this outcome as moderate. The estimated absolute effect, -53.38 per 1000 (from -84 to -16), falls in the range of an effect of moderate magnitude.
Conclusions
Remdesivir may result in a slight reduction in mortality.
Remdesivir may result in a reduction in mechanical ventilation requirement.
Remdesivir probably results in a reduction in serious adverse events.