The efficacy of remdesivir in coronavirus disease 2019 (COVID-19): a systematic review

  1. Amirhossein Roshanshad
  2. Alireza Kamalipour
  3. Mohammad Ali Ashraf
  4. Romina Roshanshad
  5. Sirous Jafari
  6. Pershang Nazemi
  7. Mohammadreza Akbari

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Abstract

Background and Objectives: Researchers all around the world are working hard to find an effective treatment for the new coronavirus 2019. We performed a comprehensive systematic review to investigate the latest clinical evidence on the efficacy and safety of treatment with Remdesivir in hospitalized patients with COVID-19. Materials and Methods: We performed a systematic search in Pubmed, Embase, Web of Science, Google scholar and MedRxiv for relevant observational and interventional studies. The outcomes measures were mortality rates, improvement rates, time to clinical improvement, all adverse event rates and severe adverse event rates. Results: Three randomized controlled trials and 2 cohort studies were included in our study. In the 2 cohort studies, patients received Remdesivir for 10 days. 2 RCTs evaluated 10-day efficacy of treatment with Remdesivir versus placebo group and the other RCT compared its 5-day regimen versus 10-day regimen. Visual inspection of the forest plots revealed that the efficacy of Remdesivir was not much different in reducing 28-day mortality versus 14-day mortality rates. Besides, 10-day treatment regimen overpowered 5-day treatment and placebo in decreasing time to clinical improvement. All adverse event rates did not have a significant difference; however, severe adverse event rate was lower in the 5-day Remdesivir group compared to the 10-day and placebo groups. Conclusion: 5-day course of Remdesivir therapy in COVID-19 patients is probably efficacious and safe, and patients without invasive mechanical ventilation benefit the most. Treatment can be extended to 10 days if satisfactory improvement is not seen by day 5. Most benefits from Remdesivir therapy take place in the first 14 days of the start of the treatment.

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  1. Version published to 10.18502/ijm.v12i5.4597
  2. ScreenIT

    SciScore for 10.1101/2020.06.15.20131227: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    RandomizationRisk of bias assessment: We use Cochrane Risk of Bias Tool (12) and Newcastle-Ottawa Scale(13) for assessing risk of bias of randomized controlled studies and observational studies, respectively.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Literature search: We performed a systematic search of the MEDLINE(PubMed), EMBASE, and Web of Science databases with the MeSH and non-MeSH terms and the keywords of ‘coronavirus’ OR ‘COVID-19’ OR ‘SARS-COV-2’ OR ‘2019-ncov’ AND ‘GS-5734’ OR ‘Remdesivir’ on May 29, 2020.
    EMBASE
    suggested: (EMBASE, RRID:SCR_001650)
    MeSH
    suggested: (MeSH, RRID:SCR_004750)
    Google scholar and MedRxiv were also searched with these keywords manually to retrieve gray literature.
    Google scholar
    suggested: (Google Scholar, RRID:SCR_008878)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has three major limitations. Firstly, only five articles were eligible to enter our study, at least three of them (15, 16, 19) did not have enough sample sizes in different clinical subgroups. Therefore, comparing these subgroups regarding the efficacy of Remdesivir was not incontrovertible. Second, pooling the data of the original articles was impossible due to heterogeneity in study design and reported outcomes. However, critical review of the study settings and methods and their associations with the reported results have enable us to compare the differences observed in results of these studies. Third, lack of control arm in 2 cohort studies(15, 16) and differences in baseline characteristics between test and control arms in 2 RCTs(17, 19), made it difficult to suggest a conclusive statement for the efficacy of Remdesivir in treating COVID-19.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.06.15.20131227v1 on medRxiv