Minneapolis VA Health Care System and University of Minnesota School of Medicine, Minneapolis, Minnesota (A.S.K., W.D., T.J.W.).
Minneapolis VA Health Care System, Minneapolis, Minnesota (R.M., N.G.).
Ann Intern Med. 2021 May;174(5):663-672. doi: 10.7326/M20-8148. Epub 2021 Feb 9.
Remdesivir is being studied and used for treatment of coronavirus disease 2019 (COVID-19).
To update a previous review of remdesivir for adults with COVID-19, including new meta-analyses of patients with COVID-19 of any severity compared with control.
Several sources from 1 January 2020 through 7 December 2020.
English-language, randomized controlled trials (RCTs) of remdesivir for COVID-19. New evidence is incorporated by using living review methods.
1 reviewer abstracted data; a second reviewer verified the data. The Cochrane Risk of Bias Tool and GRADE (Grading of Recommendations Assessment, Development and Evaluation) method were used.
The update includes 5 RCTs, incorporating data from a new large RCT and the final results of a previous RCT. Compared with control, a 10-day course of remdesivir probably results in little to no reduction in mortality (risk ratio [RR], 0.93 [95% CI, 0.82 to 1.06]; 4 RCTs) but may result in a small reduction in the proportion of patients receiving mechanical ventilation (RR, 0.71 [CI, 0.56 to 0.90]; 3 RCTs). Remdesivir probably results in a moderate increase in the percentage of patients who recovered and a moderate decrease in serious adverse events and may result in a large reduction in time to recovery. Effect on hospital length of stay or percentage remaining hospitalized is mixed. Compared with a 10-day course for those not requiring ventilation at baseline, a 5-day course may reduce mortality, the need for ventilation, and serious adverse events while increasing the percentage of patients who recovered or clinically improved.
Summarizing findings was challenging because of varying disease severity definitions and outcomes.
In hospitalized adults with COVID-19, remdesivir probably results in little to no mortality difference but probably improves the percentage recovered and reduces serious harms and may result in a small reduction in the proportion receiving ventilation. For patients not receiving ventilation, a 5-day course may provide greater benefits and fewer harms with lower drug costs than a 10-day course.
U.S. Department of Veterans Affairs.
瑞德西韦正在被研究并用于治疗 2019 年冠状病毒病（COVID-19）。
更新之前对瑞德西韦治疗 COVID-19 成人患者的综述，包括对任何严重程度 COVID-19 患者与对照组进行的新的荟萃分析。
2020 年 1 月 1 日至 2020 年 12 月 7 日的多个来源。
瑞德西韦治疗 COVID-19 的英语随机对照试验（RCT）。使用实时审查方法纳入新证据。
1 位审查员摘录数据；第二位审查员验证数据。使用 Cochrane 偏倚风险工具和 GRADE（推荐评估、制定与评价）方法。
更新内容包括 5 项 RCT，纳入了一项新的大型 RCT 数据和之前一项 RCT 的最终结果。与对照组相比，10 天疗程的瑞德西韦治疗可能对死亡率几乎没有影响（风险比 [RR]，0.93 [95% CI，0.82 至 1.06]；4 项 RCT），但可能会使接受机械通气的患者比例略有降低（RR，0.71 [CI，0.56 至 0.90]；3 项 RCT）。瑞德西韦治疗可能会使恢复的患者比例适度增加，严重不良事件适度减少，并且可能使康复时间大大缩短。对住院时间或住院患者比例的影响则不一致。与基线时不需要通气的患者 10 天疗程相比，5 天疗程可能会降低死亡率、通气需求和严重不良事件发生率，同时提高恢复或临床改善的患者比例。
由于疾病严重程度定义和结局的差异，总结发现结果具有挑战性。
在住院的 COVID-19 成人患者中，瑞德西韦治疗可能对死亡率影响不大，但可能会提高恢复率并降低严重危害，还可能使接受通气的患者比例略有减少。对于未接受通气的患者，5 天疗程的药物成本更低，可能比 10 天疗程提供更大的益处和更少的危害。
美国退伍军人事务部。
