Effects of remdesivir in patients hospitalised with COVID-19: a systematic review and individual patient data meta-analysis of randomised controlled trials. 2/24/2023. Amstutz A. Lancet Respir Med.

The authors found nine eligible RCTs, covering 10 480 patients recruited between Feb 6, 2020, and April 1, 2021. Overall, 28-day mortality was 12·5% of 5317 patients assigned to remdesivir and 14·1% of 5005 patients assigned to no remdesivir. Of patients who were ventilated or received high-flow oxygen, 28-day mortality was 30·0% for patients assigned to remdesivir compared with 28·5% for patients assigned to no remdesivir. Of patients who received no oxygen or low-flow oxygen, 28-day mortality was 9·1% for patients assigned to remdesivir compared with 11·2% for patients assigned to no remdesivir.

SAB comment: While the initial NIH ACTT-1 randomized controlled trial in early 2020 showed a significant benefit achieved with remdesivir infusion, many clinicians have since been unconvinced of its effectiveness in their patients. These pooled results (of largely unvaccinated patients and which don’t include patients with the Delta or Omicron strains) suggest that remdesivir may not be effective in saving lives in patients requiring intensive respiratory support but may be somewhat effective in patients with milder respiratory impairment.


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