Summary

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• Remdesivir (Veklury) is indicated for the treatment of COVID-19 in adults and pediatric patients, regardless of hospitalization status, but especially for those at high risk of progressing to severe disease. It potentially reduces all-cause mortality and the duration of hospitalization, especially when started early in the disease course.
• A total of 50 systematic reviews/meta-analyses, which included randomized controlled trials and observational studies on remdesivir's therapeutic effects against COVID-19, were evaluated.
• Compared to standard care, remdesivir results in higher clinical improvement rates without a significant increase in serious adverse events. However, its impact on reducing the need for mechanical ventilation or ICU admission varies.
• The effectiveness of remdesivir may depend on how early treatment is initiated, with early treatment being potentially more beneficial. There is limited data on its use in specific groups such as pediatric patients and pregnant women, indicating a need for more research.
• When compared with other treatments like corticosteroids and IL6 inhibitors, which might offer survival benefits in severe cases of COVID-19, remdesivir is primarily considered an early intervention aimed at preventing disease progression rather than as a treatment in the late stages.
• Other antiviral agents like hydroxychloroquine and lopinavir/ritonavir have not shown significant benefits in treating COVID-19, making remdesivir a more favorable option, especially compared to treatments with unclear outcomes or potential harms.
• The evidence indicates interest in combination therapies including remdesivir with corticosteroids or immune modulating drugs, which could optimize outcomes, particularly for those with moderate-to-severe cases; however, this requires confirmation through additional research.
• Future research should focus on conducting randomized controlled trials involving broader demographic groups, including children and pregnant women; evaluating long-term outcomes and post-recovery effects following remdesivir treatment; investigating optimal combination therapies for effective use; and assessing its cost-effectiveness in varying health system contexts.