Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan.
Division of Pulmonary, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
J Antimicrob Chemother. 2021 Jul 15;76(8):1962-1968. doi: 10.1093/jac/dkab093.
We performed a systematic review and network meta-analysis of randomized controlled trials (RCTs) to provide updated information regarding the clinical efficacy of remdesivir in treating coronavirus disease 2019 (COVID-19).
PubMed, Embase, Cochrane Library, clinical trial registries of ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched for relevant articles published up to 18 November 2020.
Five RCTs, including 13 544 patients, were included in this meta-analysis. Among them, 3839 and 391 patients were assigned to the 10 day and 5 day remdesivir regimens, respectively. Patients receiving 5 day remdesivir therapy presented greater clinical improvement than those in the control group [OR = 1.68 (95% CI 1.18-2.40)], with no significant difference observed between the 10 day and placebo groups [OR = 1.23 (95% CI 0.90-1.68)]. Patients receiving remdesivir revealed a greater likelihood of discharge [10 day remdesivir versus control: OR = 1.32 (95% CI 1.09-1.60); 5 day remdesivir versus control: OR = 1.73 (95% CI 1.28-2.35)] and recovery [10 day remdesivir versus control: OR = 1.29 (95% CI 1.03-1.60); 5 day remdesivir versus control: OR = 1.80 (95% CI 1.31-2.48)] than those in the control group. In contrast, no mortality benefit was observed following remdesivir therapy. Furthermore, no significant association was observed between remdesivir treatment and an increased risk of adverse events.
Remdesivir can help improve the clinical outcome of hospitalized patients with COVID-19 and a 5 day regimen, instead of a 10 day regimen, may be sufficient for treatment. Moreover, remdesivir appears as tolerable as other comparators or placebo.
我们进行了一项系统评价和网络荟萃分析，以评估瑞德西韦治疗 2019 冠状病毒病（COVID-19）的临床疗效，为大家提供最新的相关信息。
检索 PubMed、Embase、Cochrane 图书馆、ClinicalTrials.gov 和世界卫生组织国际临床试验注册平台的临床试验注册库，截至 2020 年 11 月 18 日，获取相关文献。
本荟萃分析纳入了 5 项 RCT，共纳入 13544 例患者。其中，3839 例和 391 例患者分别接受了 10 天和 5 天瑞德西韦治疗方案。与对照组相比，接受 5 天瑞德西韦治疗的患者临床改善更为显著[OR=1.68（95%CI 1.18-2.40)]，而 10 天瑞德西韦组与安慰剂组之间无显著差异[OR=1.23（95%CI 0.90-1.68)]。接受瑞德西韦治疗的患者出院[10 天瑞德西韦与对照组：OR=1.32（95%CI 1.09-1.60）；5 天瑞德西韦与对照组：OR=1.73（95%CI 1.28-2.35）]和恢复[10 天瑞德西韦与对照组：OR=1.29（95%CI 1.03-1.60）；5 天瑞德西韦与对照组：OR=1.80（95%CI 1.31-2.48）]的可能性均高于对照组。但瑞德西韦治疗并未降低患者死亡率。此外，瑞德西韦治疗与不良反应风险增加之间无显著相关性。
瑞德西韦可改善住院 COVID-19 患者的临床结局，与 10 天方案相比，5 天方案可能足以治疗 COVID-19。而且，瑞德西韦的耐受性与其他对照药物或安慰剂相当。
