Summary

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• This summary is based on the review of 97 systematic review(s)/meta-analysis(es). ^[1-97]
• Remdesivir demonstrated a significant benefit in clinical progression and recovery for hospitalized patients with COVID-19, showing improved clinical progression (relative risk (RR) 1.06, 95% 0.48,0.68 (confidence interval (CI)) 1.02-1.11) and decreased clinical deterioration (RR 0.75, 95% CI 0.61-0.89), with a recovery rate 1.29 times higher than control (RR 1.29, 95% CI 1.03-1.60) and reducing time to clinical improvement by approximately 2.99 days (95% CI 2.71-3.28).
• The effect of remdesivir on mortality was mixed; it showed a potential reduction in mortality overall (RR 0.90, 95% CI 0.83-0.98), particularly in non-critically ill patients requiring low-flow oxygen (RR 0.74, 95% CI 0.49-1.11), while having no significant benefit for critically ill patients requiring mechanical ventilation (RR 0.96, 95% CI 0.87-1.04).
• Remdesivir was associated with a reduced need for mechanical ventilation (RR 0.68, 95% CI 0.51-0.90) and invasive mechanical ventilation or odds ratio (OR): 0.59, 95% CI: 0.46-0.76 (extracorporeal membrane oxygenation (ECMO)) (OR 0.59, 95% CI 0.46-0.76), along with benefits in reducing ICU (intensive care unit) admissions (OR 2.39, 95% CI 1.24-4.57), especially for outpatients with mild to moderate disease (RR 0.13, 95% CI 0.03-0.59) and for all-cause hospitalization (RR 0.28, 95% CI 0.10-0.75).
• Remdesivir did not result in a significant increase in adverse events compared to placebo (RR 0.98, 95% CI 0.91-1.06), while there was a noted reduction in serious adverse events (RR 0.77, 95% CI 0.57-1.03), indicating a favorable safety profile.
• The use of remdesivir was associated with a higher risk of bradycardia (OR 2.556, 95% CI 2.049-3.188); however, this did not correlate with an increase in mortality rates. Additionally, remdesivir did not significantly affect liver or kidney function, with risk ratios of RR 0.87 (95% CI 0.68-1.11) for liver damage and RR 0.88 (95% CI 0.70-1.10) for kidney damage.
• In patients with renal impairment, remdesivir showed no significant increase in adverse effects, suggesting it may be safer for this population than previously thought. Limited safety data for pregnant women and pediatric patients indicate potential benefits, though further investigation is required to confirm safety and efficacy in these groups.
• Remdesivir demonstrated a better safety profile compared to hydroxychloroquine, which increased the risk of cardiac toxicity and cognitive dysfunction, and had fewer gastrointestinal adverse effects compared to lopinavir/ritonavir.
• Most studies on remdesivir focused on hospitalized adults with varying severity of COVID-19, showing pronounced benefits for patients requiring supplemental oxygen but not those needing mechanical ventilation. Outpatients with mild to moderate disease demonstrated significant reductions in hospitalization rates (RR 0.13, 95% CI 0.03-0.59) and all-cause hospitalization (RR 0.28, 95% CI 0.10-0.75).
• Patients with chronic kidney disease and obesity were identified as high-risk subgroups for experiencing remdesivir-induced bradycardia (OR 2.556, 95% CI 2.049-3.188). Limited data suggest potential benefits of remdesivir for pregnant women, although further investigation into safety and efficacy is necessary, and data on pediatric patients are currently insufficient.