Objective: Provide a timely, rigorous and continuously updated summary of the evidence on the role of remdesivir in the treatment of patients with COVID-19.
Methods: Eligible studies were randomized trials evaluating the effect of remdesivir versus placebo or no treatment . We conducted searches in the special L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that performs regular searches in databases, trial registries, preprint servers and websites relevant to COVID-19 . All the searches covered the period until 25 August 2020 . No date or language restrictions were applied . Two reviewers independently evaluated potentially eligible studies according to predefined selection criteria, and extracted data on study characteristics, methods, outcomes, and risk of bias, using a predesigned, standardized form . We performed meta-analyses using random-effect models and assessed overall certainty in evidence using the GRADE approach . A living, web-based version of this review will be openly available during the COVID-19 pandemic .
Results: Our search strategy yielded 574 references . Finally, we included three randomized trials evaluating remdesivir in addition to standard care versus standard care alone . The evidence is very uncertain about the effect of remdesivir on mortality (RR 0.7 , 95% CI 0.46 to 1.05; very low certainty evidence) and the need for invasive mechanical ventilation (RR 0.69 , 95% CI 0.39 to 1.24; very low certainty evidence). On the other hand, remdesivir likely results in a large increase in the incidence of adverse effects in patients with COVID-19 (RR 1.29 , 95% CI 0.58 to 2.84; moderate certainty evidence).
Conclusions: The evidence is insufficient for the outcomes critical for making decisions on the role of remdesivir in the treatment of patients with COVID-19, so it is impossible to balance potential benefits, if there are any, with the adverse effects and costs . PROSPERO registration number: CRD42020183384.