Epistemonikos Foundation, Santiago, Chile; UC Evidence Center, Cochrane Chile Associated Center, Pontificia Universidad Católica de Chile, Santiago, Chile. Dirección: Holanda 895, Providencia, Santiago, Chile. Email:
Unidad de Infectología, Hospital Dr Sótero del Río, Santiago, Chile; Unidad de Infectología, Hospital Clínico Dra Eloísa Díaz, La Florida, Santiago, Chile. ORCID: 0000-0001-7003-495X.
Medwave. 2020 Dec 9;20(11):e8080. doi: 10.5867/medwave.2020.11.8080.
Provide a timely, rigorous and continuously updated summary of the evidence on the role of remdesivir in the treatment of patients with COVID-19.
Eligible studies were randomized trials evaluating the effect of remdesivir versus placebo or no treatment. We conducted searches in the special L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that performs regular searches in databases, trial registries, preprint servers and websites relevant to COVID-19. All the searches covered the period until 25 August 2020. No date or language restrictions were applied. Two reviewers independently evaluated potentially eligible studies according to predefined selection criteria, and extracted data on study characteristics, methods, outcomes, and risk of bias, using a predesigned, standardized form. We performed meta-analyses using random-effect models and assessed overall certainty in evidence using the GRADE approach. A living, web-based version of this review will be openly available during the COVID-19 pandemic.
Our search strategy yielded 574 references. Finally, we included three randomized trials evaluating remdesivir in addition to standard care versus standard care alone. The evidence is very uncertain about the effect of remdesivir on mortality (RR 0.7, 95% CI 0.46 to 1.05; very low certainty evidence) and the need for invasive mechanical ventilation (RR 0.69, 95% CI 0.39 to 1.24; very low certainty evidence). On the other hand, remdesivir likely results in a large increase in the incidence of adverse effects in patients with COVID-19 (RR 1.29, 95% CI 0.58 to 2.84; moderate certainty evidence).
The evidence is insufficient for the outcomes critical for making decisions on the role of remdesivir in the treatment of patients with COVID-19, so it is impossible to balance potential benefits, if there are any, with the adverse effects and costs.
CRD42020183384.
及时、严格地对瑞德西韦治疗 COVID-19 患者的作用进行证据综述，并不断更新。
合格的研究为评价瑞德西韦与安慰剂或无治疗对照的疗效的随机试验。我们在专门的 L·OVE（证据综述平台）中对 COVID-19 进行了检索，该系统定期在数据库、试验登记处、预印本服务器和与 COVID-19 相关的网站中进行检索。所有检索均涵盖截至 2020 年 8 月 25 日的时间段。未对检索时间和语言进行限制。两位审查员根据预先设定的选择标准独立评估潜在合格的研究，并使用预先设计的标准化表格提取关于研究特征、方法、结局和偏倚风险的数据。我们使用随机效应模型进行荟萃分析，并使用 GRADE 方法评估证据的总体确定性。在 COVID-19 大流行期间，本综述的实时、基于网络的版本将公开可用。
我们的检索策略共产生了 574 条参考文献。最终，我们纳入了三项评价瑞德西韦联合标准治疗与标准治疗相比的随机试验。瑞德西韦对死亡率（RR 0.7，95%CI 0.46 至 1.05；极低确定性证据）和有创机械通气需求（RR 0.69，95%CI 0.39 至 1.24；极低确定性证据）的影响的证据非常不确定。另一方面，瑞德西韦可能会导致 COVID-19 患者不良反应的发生率显著增加（RR 1.29，95%CI 0.58 至 2.84；中等确定性证据）。
对于瑞德西韦治疗 COVID-19 患者的作用决策至关重要的结局，证据不足，因此无法权衡可能的益处（如果有的话）与不良反应和成本。
PROSPERO 注册号：CRD42020183384。
