• Anjum S Kaka, Roderick MacDonald, Eric J Linskens, Lisa Langsetmo, Kathryn Vela, Wei Duan-Porter, and Timothy J Wilt.
• Minneapolis VA Section of Infectious Diseases and University of Minnesota School of Medicine, Minneapolis, Minnesota (A.S.K.).
• Ann. Intern. Med. 2022 May 1; 175 (5): 701-709.

BackgroundRemdesivir is approved for the treatment of adults hospitalized with COVID-19.PurposeTo update a living review of remdesivir for adults with COVID-19.Data SourcesSeveral electronic U.S. Food and Drug Administration, company, and journal websites from 1 January 2020 through 19 October 2021.Study SelectionEnglish-language, randomized controlled trials (RCTs) of remdesivir for COVID-19.Data ExtractionOne reviewer abstracted, and a second reviewer verified data. The Cochrane Risk of Bias Tool and GRADE (Grading of Recommendations Assessment, Development and Evaluation) method were used.Data SynthesisSince the last update (search date 9 August 2021), 1 new RCT and 1 new subtrial comparing a 10-day course of remdesivir with control (placebo or standard care) were identified. This review summarizes and updates the evidence on the cumulative 5 RCTs and 2 subtrials for this comparison. Our updated results confirm a 10-day course of remdesivir, compared with control, probably results in little to no mortality reduction (5 RCTs). Updated results also confirm that remdesivir probably results in a moderate increase in the proportion of patients recovered by day 29 (4 RCTs) and may reduce time to clinical improvement (2 RCTs) and hospital length of stay (4 RCTs). New RCTs, by increasing the strength of evidence, lead to an updated conclusion that remdesivir probably results in a small reduction in the proportion of patients receiving ventilation or extracorporeal membrane oxygenation at specific follow-up times (4 RCTs). New RCTs also alter the conclusions for harms-remdesivir, compared with control, may lead to a small reduction in serious adverse events but may lead to a small increase in any adverse event.LimitationThe RCTs differed in definitions of COVID-19 severity and outcomes reported.ConclusionIn hospitalized adults with COVID-19, the findings confirm that remdesivir probably results in little to no difference in mortality and increases the proportion of patients recovered. Remdesivir may reduce time to clinical improvement and may lead to small reductions in serious adverse events but may result in a small increase in any adverse event.Primary Funding SourceU.S. Department of Veterans Affairs.

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