• Anjum S Kaka, Roderick MacDonald, Nancy Greer, Kathryn Vela, Wei Duan-Porter, Adam Obley, and Timothy J Wilt.
• Minneapolis VA Health Care System and University of Minnesota School of Medicine, Minneapolis, Minnesota (A.S.K., W.D., T.J.W.).
• Ann. Intern. Med. 2021 May 1; 174 (5): 663672663-672.

BackgroundRemdesivir is being studied and used for treatment of coronavirus disease 2019 (COVID-19).PurposeTo update a previous review of remdesivir for adults with COVID-19, including new meta-analyses of patients with COVID-19 of any severity compared with control.Data SourcesSeveral sources from 1 January 2020 through 7 December 2020.Study SelectionEnglish-language, randomized controlled trials (RCTs) of remdesivir for COVID-19. New evidence is incorporated by using living review methods.Data Extraction1 reviewer abstracted data; a second reviewer verified the data. The Cochrane Risk of Bias Tool and GRADE (Grading of Recommendations Assessment, Development and Evaluation) method were used.Data SynthesisThe update includes 5 RCTs, incorporating data from a new large RCT and the final results of a previous RCT. Compared with control, a 10-day course of remdesivir probably results in little to no reduction in mortality (risk ratio [RR], 0.93 [95% CI, 0.82 to 1.06]; 4 RCTs) but may result in a small reduction in the proportion of patients receiving mechanical ventilation (RR, 0.71 [CI, 0.56 to 0.90]; 3 RCTs). Remdesivir probably results in a moderate increase in the percentage of patients who recovered and a moderate decrease in serious adverse events and may result in a large reduction in time to recovery. Effect on hospital length of stay or percentage remaining hospitalized is mixed. Compared with a 10-day course for those not requiring ventilation at baseline, a 5-day course may reduce mortality, the need for ventilation, and serious adverse events while increasing the percentage of patients who recovered or clinically improved.LimitationSummarizing findings was challenging because of varying disease severity definitions and outcomes.ConclusionIn hospitalized adults with COVID-19, remdesivir probably results in little to no mortality difference but probably improves the percentage recovered and reduces serious harms and may result in a small reduction in the proportion receiving ventilation. For patients not receiving ventilation, a 5-day course may provide greater benefits and fewer harms with lower drug costs than a 10-day course.Primary Funding SourceU.S. Department of Veterans Affairs.

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