Razzack Aminah Abdul, Hassan Syed Adeel, Pasya Sai Kumar Reddy, Erasani Greeshma, Kumar Sham, Rocha-Castellanos Dario Missael, Lopez-Mendez Alfonso, Razzack Sarah Abdul
Department of Internal Medicine, Dr. NTR University of Health Sciences, Vijayawada, India.
Department of Medicine, University of Louisville, Kentucky, USA.
Infect Chemother. 2021 Sep;53(3):512-518. doi: 10.3947/ic.2021.0060. Epub 2021 Aug 30.
The World Health Organization guidelines did not make a recommendation on use of remdesivir based on disease severity. Little is known regarding effectiveness of remdesivir in critically ill coronavirus disease 2019 (COVID-19) patients. This has led to a state of dilemma for doctors leaving them skeptical of whether they should continue to recommend the drug or not.
A systematic search adhering to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was conducted from inception until February 20, 2020. Electronic bibliographic databases (PubMed, Cochrane database, Scopus, Embase) were included. Using dichotomous data for select values, the unadjusted odds ratios (ORs) were calculated applying Mantel Haenszel (M-H) using random-effects model. The primary outcome of interest was all-cause mortality in ventilated and non-ventilated patients.
The Remdesivir arm was associated with similar rates of 28-day all-cause mortality (OR: 0.93, 95% confidence interval [CI]: 0.80 - 1.08; = 0.33). Remdesivir was not found to be favorable for ventilated patients. Non ventilated COVID-19 patients showed a significant lower in-hospital mortality rate as compared with patients requiring mechanical ventilatory support (OR: 6.86, 95% CI: 5.39 - 268.74; <0.0001).
Non-ventilated patients were associated with significant lower all-cause mortality rates. Prudent use of remdesivir is recommended in critically ill COVID-19 patients.
世界卫生组织的指南未根据疾病严重程度对使用瑞德西韦提出建议。关于瑞德西韦在危重型2019冠状病毒病（COVID-19）患者中的有效性知之甚少。这使医生陷入两难境地，他们对是否应继续推荐该药物持怀疑态度。
从开始到2020年2月20日，按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行了系统检索。纳入了电子书目数据库（PubMed、Cochrane数据库、Scopus、Embase）。对于选定值使用二分数据，采用随机效应模型应用Mantel Haenszel（M-H）法计算未调整比值比（OR）。感兴趣的主要结局是通气和未通气患者的全因死亡率。
瑞德西韦组的28天全因死亡率相似（OR：0.93，95%置信区间[CI]：0.80 - 1.08；P = 0.33）。未发现瑞德西韦对通气患者有益。与需要机械通气支持的患者相比，未通气的COVID-19患者院内死亡率显著更低（OR：6.86，95% CI：5.39 - 268.74；P <0.0001）。
未通气患者的全因死亡率显著更低。建议在危重型COVID-19患者中谨慎使用瑞德西韦。
