Mortality Benefit of Remdesivir in COVID-19: A Systematic Review and Meta-Analysis

<b>Importance/Background:</b> During current public health emergency of COVID-19 pandemic, repurposing of existing antiviral drugs may be an efficient strategy since there is no proven effective treatment. Published literature shows Remdesivir has broad-spectrum antiviral activity against numerous RNA viruses and has been recently recognized as a promising therapy against SARS-CoV-2. <b>Methods:</b> A systematic search was conducted for full length manuscripts published between inception and July 19th, 2020 focussing on efficacy and safety of Remdesivir in COVID-19. The primary outcomes were defined as mortality rate and median days to recovery based on the available pooled data. The secondary outcome was adverse events rate and drug discontinuation rate. <b>Statistical Analysis:</b> All outcomes were performed using Comprehensive Meta-Analysis software package (Bio stat, Englewood, NJ, USA). <b>Results:</b> A total of 1,895 patients from 9 studies were included in this qualitative synthesis. In patients treated with Remdesivir, the mean recovery time was 15.84 days (95% CI 11.68-20, SE 2.12; <i>I</i> ² = 97.24) and the pooled mortality rate was 11.3% (95% CI 7.9-16%; <i>I</i> ² = 74.85). However, treatment with Remdesivir was associated with adverse effects (55.3%, 95% CI 31.5-76.9%; <i>I</i> ² = 97.66) eventually warranting the discontinuation of the drug (17.8%, 95% CI 8.6-33.1%; <i>I</i> ² = 95.64). The meta-analysis of three clinical trials indicated that administration of Remdesivir significantly reduces the mortality compared to the placebo (OR 0.70, 95% CI 0.58-0.84, <i>p</i> ≤ 0.001; <i>I</i> ² = 16.6). <b>Conclusions and Relevance:</b> The result of contemporary meta-analysis suggests mortality benefit with Remdesivir in COVID-19 and median recovery time was over 2 weeks. The pooled mortality with Remdesivir was found to be very low, and this analysis can shed light on this potential treatment for COVID-19 patients.