The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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The effects of remdesivir on mortality and the requirement for mechanical ventilation in patients with COVID-19: a systematic review stratified by disease severity

  • Seungeun Ryoo (Division of Health Technology Assessment, National Evidence-Based Healthcare Collaborating Agency) ;
  • Miyoung Choi (Division of Health Technology Assessment, National Evidence-Based Healthcare Collaborating Agency) ;
  • Su-Yeon Yu (College of Nursing and Health, Kongju National University) ;
  • Young Kyung Yoon (Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine) ;
  • Kyungmin Huh (Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Eun-Jeong Joo (Division of Infectious Diseases, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
  • Received : 2023.08.24
  • Accepted : 2023.10.23
  • Published : 2024.01.01
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Abstract

Background/Aims: The effectiveness of remdesivir treatment in reducing mortality and the requirement for mechanical ventilation (MV) remains uncertain, as randomized controlled trials (RCTs) have produced conflicting results. Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and other data resources to find RCTs published prior to April 10, 2023. The selection of studies, assessment of risk of bias, and meta-analysis were conducted according to PRISMA guidelines. The primary outcomes were all-cause mortality and the need to initiate MV. Results: A total of 5,068 articles were screened, from eight RCTs comprising 11,945 patients. The meta-analysis found that, compared to standard care or placebo, remdesivir treatment provided no significant all-cause mortality benefit (pooled risk ratio [RR], 0.93; 95% confidence interval [CI], 0.85-1.02; 8 studies; high certainty evidence), while subgroup analyses revealed a trend towards reduced mortality among patients requiring oxygen but not MV (pooled RR, 0.88; 95% CI, 0.77-1.00; 6 studies; I2 = 4%). The need to initiate MV (pooled RR, 0.74; 95% CI, 0.59-0.94; 7 studies; moderate certainty evidence) in remdesivir-treated patients was also reduced compared to controls. Remdesivir significantly increased clinical improvement and discharge and significantly reduced serious adverse events. Conclusions: In this systematic review and meta-analysis of RCTs, it was found that remdesivir treatment did not show a substantial decrease in the risk of mortality. However, it was linked to a reduction in the necessity for additional ventilator support, suggesting remdesivir could be beneficial for COVID-19 patients, particularly those who are not on MV.

Keywords

Acknowledgement

This research was supported by National Evidence-based Healthcare Collaborating Agency (NECA-P-21-004, NECA-A-22-008, NECA-A-23-010).

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