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The efficacy and safety of remdesivir in the treatment of patients with COVID-19: a systematic review and meta-analysis

By Lixiang Lou, Hui Zhang, Zeqing Li, Baoming Tang, Zhaowei Li

Posted 13 Mar 2021
medRxiv DOI: 10.1101/2021.03.12.21253470

Background: The global total of COVID-19 cases will reach 20 million this week, with 750,000 deaths. It has spread to more than 200 countries and regions around the world. At present, the global pandemic continues to rise and continues to spread worldwide. It is necessary to explore the effective and safe treatment of COVID-19 as soon as possible. Remdesiviras was an antiviral agent with therapeutic potential, but it was still controversial. Objective: Through systematic review and meta-analysis, to evaluate the effect and safety of remdesivir in the treatment of patients with COVID-19, and will provide a reliable reference for the treatment of COVID-19. Methods: We used the following search string: "COVID-19" [Mesh], "remdesivir" [Mesh], "randomized controlled trial" [Mesh]. We used the Medical Subject Heading (MeSH) terms and corresponding keywords to make the search strategy. We searched six databases, PubMed, EMBASE, Cochrane Library, Web of Science, clinical trials.gov and chictr.org.cn. Data analyses were conducted by using the software Review Manager 5.3 and STATA version 14.0. Results: Our systematic search identified 5 meta-analyses of RCTs, including 1782 patients with COVID-19.The clinical improvement of remdesivir in the treatment of COVID-19 was superior to the placebo-controlled group (relative risk (RR) =1.17, 95% confidence interval (CI)=1.07-1.29, p= 0.0009). The following are the Single-Arm Study, Meta-analysis results. The pooled prevalence of clinical improvement significant findings was 62% (95% CI = 59-65%, p=0.00), during treatment of COVID-19 with remdesivir. The incidence rates of Acute kidney injury ,Hepatic enzyme increased , Any serious adverse event were 5% (95%CI=3-7%, p=0.00), 11%(95%CI=5-16%, p=0.00), 22%(95%CI=18-27%, p =0.00), respectively, and the mortality was 13%(95%CI=8-19%, p=0.00), during treatment of COVID-19 with remdesivir. Conclusion: This analysis confirms that remdesivir is effective in the clinical improvement of COVID-19 patients, and the rate of clinical improvement was 62%. In addition, adverse events and mortality should also be paid attention to. Future research should aim that more large-scale studies were needed to confirm the results, to further elucidate the underlying mechanisms.

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