The use of remdesivir for the management of patients with moderate-to-severe COVID-19: a systematic review

ABSTRACT

Objective

We systematically reviewed the evidence of published original research to determine the role of remdesivir in the management of patients with COVID-19 and a moderate-to-severe course of illness.

Methods

A systematic search of articles was conducted in scientific databases, with the latest update in May 2021. This paper systematically reviewed the clinical evidence available (randomized controlled trials, compassionate use studies, and case reports) on the use of remdesivir for patients with moderate or severe COVID-19.

Results

A total of eleven studies were included: four studies based on compassionate use of remdesivir, three randomized, double-blind, placebo-controlled, multicentre trials, three randomized, open-label, phase III trials, and one case report. Clinical improvement and mortality rates in patients who used remdesivir varied across studies.

Conclusion

Given the current evidence, there is insufficient data to confidently recommend the use of remdesivir alone for the treatment of adult hospitalized patients with moderate-to-severe COVID-19. However, remdesivir may be considered along with an anti-inflammatory agent in patients with pneumonia, on oxygen support, provided there is close monitoring of clinical and laboratory parameters and adverse events.

KEYWORDS:

• Adverse events
• critically ill
• evidence-based medicine
• remdesivir
• SARS-CoV-2

Article highlights

• Remdesivir exhibited good in-vitro activity and is approved for use in patients with COVID-19.

• The evidence depicts mixed findings regarding the efficacy of remdesivir.

• The use of remdesivir with an anti-inflammatory agent (e.g. baricitinib) might be considered in hospitalized patients with moderate-to-severe COVID-19 to accelerate their recovery.

Authors’ contributions

KT drafted the manuscript, and KT, CSK, MAH, and SSH equally contributed to the revision of the manuscript in its final form. All authors read and approved the final manuscript.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This study was not funded.