The Effectiveness and Safety of Remdesivir for the Treatment of Patients With COVID-19: A Systematic Review and Meta-Analysis

Background: Coronavirus disease 2019 (COVID-19) is a pandemic disease that has significant implications on the global health burden. Currently, there is no widely accepted pharmacologic treatment for COVID-19. Remdesivir has been shown effective against various types of viruses, including coronaviruses. This study aimed at synthesizing the latest evidence regarding the effectiveness and safety of remdesivir as a potential treatment candidate against COVID-19. Methods: This systematic review has been registered in PROSPERO (CRD42020183707). A systematic search of the literature was conducted in PubMed, PubMed Central, and Google Scholar through June 5th, 2020. Statistical analysis was done by using the Review Manager 5.4 tool. The risk of bias was evaluated using the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) and GRADE analysis was performed to determine the certainty of the evidence. Results: Two studies with a total of 1,300 patients were included. Meta-analysis showed that remdesivir was associated with faster time to clinical improvement (MD -4.75 days; 95% CI -4.84 days to -4.65 days; p < 0.00001), reduction in mortality rate (RR 0.39; 95% CI 0.27 – 0.56; p < 0.00001) and fewer incidence of serious adverse events (RR 0.77; 95% CI 0.63 – 0.94; p = 0.01). GRADE analysis showed a high certainty for serious adverse events and moderate certainty for time to clinical improvement and mortality rate. Conclusion: Remdesivir is more effective and safer compared with standard care of treatment for the treatment of COVID-19 because it was associated with faster time to clinical improvement, reduction in mortality rate, and fewer incidence of serious adverse events.