Minneapolis VA Section of Infectious Diseases and University of Minnesota School of Medicine, Minneapolis, Minnesota (A.S.K.).
Minneapolis VA Evidence Synthesis Program, Center for Care Delivery and Outcomes Research, Minneapolis, Minnesota (R.M., E.J.L., L.L.).
Ann Intern Med. 2022 May;175(5):701-709. doi: 10.7326/M21-4784. Epub 2022 Mar 1.
Remdesivir is approved for the treatment of adults hospitalized with COVID-19.
To update a living review of remdesivir for adults with COVID-19.
Several electronic U.S. Food and Drug Administration, company, and journal websites from 1 January 2020 through 19 October 2021.
English-language, randomized controlled trials (RCTs) of remdesivir for COVID-19.
One reviewer abstracted, and a second reviewer verified data. The Cochrane Risk of Bias Tool and GRADE (Grading of Recommendations Assessment, Development and Evaluation) method were used.
Since the last update (search date 9 August 2021), 1 new RCT and 1 new subtrial comparing a 10-day course of remdesivir with control (placebo or standard care) were identified. This review summarizes and updates the evidence on the cumulative 5 RCTs and 2 subtrials for this comparison. Our updated results confirm a 10-day course of remdesivir, compared with control, probably results in little to no mortality reduction (5 RCTs). Updated results also confirm that remdesivir probably results in a moderate increase in the proportion of patients recovered by day 29 (4 RCTs) and may reduce time to clinical improvement (2 RCTs) and hospital length of stay (4 RCTs). New RCTs, by increasing the strength of evidence, lead to an updated conclusion that remdesivir probably results in a small reduction in the proportion of patients receiving ventilation or extracorporeal membrane oxygenation at specific follow-up times (4 RCTs). New RCTs also alter the conclusions for harms-remdesivir, compared with control, may lead to a small reduction in serious adverse events but may lead to a small increase in any adverse event.
The RCTs differed in definitions of COVID-19 severity and outcomes reported.
In hospitalized adults with COVID-19, the findings confirm that remdesivir probably results in little to no difference in mortality and increases the proportion of patients recovered. Remdesivir may reduce time to clinical improvement and may lead to small reductions in serious adverse events but may result in a small increase in any adverse event.
U.S. Department of Veterans Affairs.
瑞德西韦已获批准用于治疗因 COVID-19 住院的成年人。
更新瑞德西韦治疗 COVID-19 成人患者的综述。
2020 年 1 月 1 日至 2021 年 10 月 19 日，美国食品和药物管理局、公司和期刊的几个电子网站。
瑞德西韦治疗 COVID-19 的随机对照试验（RCT）的英文文献。
一位评审员摘录数据，另一位评审员验证数据。使用 Cochrane 偏倚风险工具和 GRADE（推荐评估、制定与评估）方法。
自上次更新（2021 年 8 月 9 日检索日期）以来，又有一项新的 RCT 和一项比较 10 天疗程瑞德西韦与对照（安慰剂或标准护理）的新亚组试验。本综述总结和更新了这一比较的 5 项 RCT 和 2 项亚组试验的证据。我们的更新结果证实，与对照组相比，10 天疗程的瑞德西韦可能不会降低死亡率（5 项 RCT）。更新的结果还证实，瑞德西韦可能会使第 29 天恢复的患者比例适度增加（4 项 RCT），并可能缩短临床改善时间（2 项 RCT）和住院时间（4 项 RCT）。新的 RCT 通过增强证据强度，得出了一个更新的结论，即与对照组相比，瑞德西韦可能会使特定随访时间接受通气或体外膜氧合的患者比例略有降低（4 项 RCT）。新的 RCT 也改变了瑞德西韦与对照组相比可能导致严重不良事件略有减少但可能导致不良事件略有增加的结论。
RCT 在 COVID-19 严重程度和报告结果的定义上存在差异。
在 COVID-19 住院成人中，研究结果证实，瑞德西韦可能对死亡率没有影响，并且会增加患者恢复的比例。瑞德西韦可能会缩短临床改善时间，可能会导致严重不良事件略有减少，但可能会导致不良事件略有增加。
美国退伍军人事务部。
