Effects of remdesivir in hospitalized patients with COVID-19: Systematic review and individual patient data meta-analysis of randomized trials
Abstract
Background: The interpretation of the evidence from randomized clinical trials (RCTs) on remdesivir for hospitalized patients with coronavirus disease 2019 (COVID-19) is conflicting. We conducted a systematic review and individual patient data meta-analysis (IPDMA) of RCTs to assess the benefits and harms of remdesivir compared to placebo or usual care in hospitalized patients and whether treatment effects differed between prespecified subgroups. Methods: We systematically searched electronic databases and registries through April 11th 2022 and contacted authors of eligible trials to share individual patient data. The primary outcome was all-cause mortality at day 28. We used multivariable hierarchical regression adjusting for respiratory support, age, and enrollment period to investigate effect modifiers. This study was registered in PROSPERO (CRD42021257134). Findings: Out of nine eligible RCTs, eight provided individual data for 10480 hospitalized COVID-19 patients (99% of total randomized patients globally) recruited between February 2020 and April 2021. Within 28 days of randomization, 662 of 5317 patients (12.5%) assigned to remdesivir and 706 of 5005 (14.1%) assigned to no remdesivir died (adjusted odds ratio [aOR] 0.88; 95% confidence interval [CI], 0.78-1.00; p=0.045 in the multiple imputation set / aOR 0.89; 95% confidence interval [CI], 0.79-1.00; p=0.059 in the complete case set). We found evidence for a credible subgroup effect according to respiratory support…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 662 participants or records.
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