In patients with acute COVID-19, should remdesivir be used compared to placebo?
Authors: Ramos-Rojas José , Novillo Francisco , Nava Daniel , Avila Camila , Rojas Ana , Verdugo-Paiva Francisca , Rada Gabriel , Veloso Valentina 
Published: July 2023

The aim was to assess the efficacy of remdesivir in people with acute covid-19 compared with placebo. Eligible studies were randomised trials evaluating the effect of remdesivir versus placebo. 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 132 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 0.92 (95% CI 0.83 - 1.01). This means remdesivir reduced the risk of mortality in 8%, compared with placebo. In the studies identified in this review 762 people not receiving remdesivir out of 5340 presented the outcome Mortality (143 per 1000) versus 734 out of 5477 in the group that did receive it, with a risk difference of -12 per 1000 (from -24 to 1). In other words, -12 per 1000 (from -24 to 1) 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 per 1000 (from -24 to 1), falls in the range of an effect of small magnitude. The relative risk of mechanical ventilation requirement was 0.71 (95% CI 0.41 - 1.24). This means placebo reduced the risk of mechanical ventilation requirement in 29%, compared with . In the studies identified in this review 189 people not receiving placebo out of 989 presented the outcome Mechanical ventilation requirement (191 per 1000) versus 182 out of 1195 in the group that did receive it, with a risk difference of -55 per 1000 (from -113 to 46). In other words, -55 per 1000 (from -113 to 46) people did not develop the outcome because of the intervention. We assessed the certainty of the evidence for this outcome as very low. The estimated absolute effect, -55 per 1000 (from -113 to 46), falls in the range of an effect of moderate magnitude. The relative risk of serious adverse events was 0.74 (95% CI 0.57 - 0.95). This means reduced the risk of serious adverse events in 26%, compared with . In the studies identified in this review 265 people not receiving out of 1238 presented the outcome Serious adverse events (214 per 1000) versus 256 out of 1401 in the group that did receive it, with a risk difference of -56 per 1000 (from -91 to -10). In other words, -56 per 1000 (from -91 to -10) 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, -56 per 1000 (from -91 to -10), falls in the range of an effect of moderate magnitude. Conclusions: Remdesivir may result in a slight reduction in Mortality. Remdesivir may reduce the Mechanical ventilation requirement but the evidence is very uncertain. Remdesivir probably results in a reduction in Serious adverse events.