Remdesivir for the treatment of COVID-19: A systematic review and meta-analysis of randomized controlled trials.
Remdesivir for the treatment of COVID-19: A systematic review and meta-analysis of randomized controlled trials.
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DOI：
10.1016/j.cct.2021.106272
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发表时间：
2021-03
影响因子：
2.2
通讯作者：
Michos ED
中科院分区：
文献类型：
--
作者：
Al-Abdouh A;Bizanti A;Barbarawi M;Jabri A;Kumar A;Fashanu OE;Khan SU;Zhao D;Antar AAR;Michos ED
核苷酸类似物前药remdesivir是首批在COVID-19随机对照试验（RCT）中进行测试的抗病毒疗法之一。我们进行了荟萃分析，以了解疗效和安全性。我们检索了PubMed、EMBASE、科克伦图书馆和ClinicalTrials.gov数据库（2020年1月1日至2020年11月5日）。我们纳入了比较Remdesivir与对照/安慰剂在COVID-19中的疗效和安全性的RCT。两名独立的研究人员提取数据，评估证据的质量，并对证据的确定性进行评级。共纳入4项RCT，共纳入7334例COVID-19患者。在随机化后28-29天的随访中，非常低的确定性证据表明，与对照组（安慰剂和/或标准治疗）相比，使用Remdesivir与临床改善时间的显著减少无关（标准化平均差异-0.80天; [CI，-2.12，0.53]）。然而，中等确定性的证据显示，与对照组相比，Remdesivir与恢复患者（风险差异[RD] 0.07 [0.05，0.08]）和出院患者（RD 0.07 [0.03，0.11]）的比率较高以及严重不良事件发生率较低（RD -0.05 [-0.10，-0.01]）相关。中度和极低确定性证据显示，两组在28-29天随访时的死亡（RD-0.01 [-0.03，0.01]）和发生任何不良事件（RD 0.01 [-0.17，0.19]）方面无显著差异。给予Remdesivir的患者更有可能表现出康复，并与更高的出院率相关，但与临床改善或死亡率的平均时间无关。
The nucleotide analogue prodrug remdesivir was among the first antiviral therapies to be tested in randomized controlled trials (RCTs) for COVID-19. We performed a meta-analysis to understand efficacy and safety. We searched PubMed, EMBASE, Cochrane library, and ClinicalTrials.gov databases (from January 1, 2020 to November 5, 2020). We included RCTs comparing the efficacy and safety of remdesivir to control/placebo in COVID-19. Two independent investigators abstracted data, assessed the quality of evidence, and rated the certainty of evidence. A total of 4 RCTs with 7334 patients with COVID-19 were included. At a follow-up of 28–29 days from randomization, very low certainty evidence showed that use of remdesivir compared with control group (placebo and/or standard of care) was not associated with a significant decrease in time to clinical improvement (standardized mean difference −0.80 day; [CI, −2.12, 0.53]). However, moderate certainty of evidence showed that remdesivir was associated with higher rates of recovered patients (risk difference [RD] 0.07 [0.05, 0.08]) and discharged patients (RD 0.07 [0.03, 0.11]) and lower rates of developing serious adverse events (RD -0.05 [−0.10, −0.01]) compared with control. Moderate and very low certainty of evidence showed there was no significant difference in deaths at 28–29 days follow-up (RD -0.01 [−0.03, 0.01]) and developing any adverse events (RD 0.01 [−0.17, 0.19]) between both groups, respectively. Patients given remdesivir are more likely to demonstrate recovery and were associated with higher rates of hospital discharge, but not with significant reduction in mean time to clinical improvement or mortality.
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