Covid-19 living Data

Pharmacologic treatments for covid-19 patients

Remdesivir vs Standard Care/Placebo

This comparison will not be updated. Last search date 14 Dec, 2022.

Abd-Elsalam S, Am J Trop Med Hyg, 2022 has been retracted on September 15, 2022. The study is excluded from the analysis and grade assessment.

Outpatients

Forest plots
(last update: 2022-11-04)

Summary of findings
(last update: 2022-11-15)

Patient or population: COVID-19 patients
Setting: Worldwide
Intervention: Remdesivir
Comparison: Standard Care/Placebo

Outcome	Relative effect (95% CI)	Absolute effect (95% CI)¹		Certainty of the Evidence (GRADE)
Clinical improvement D28	Outcome not yet measured or reported
Clinical improvement D60	Outcome not yet measured or reported
Hospitalisation or death	RR: 0.28 (0.10 - 0.74)	44 fewer per 1000 (from 55 fewer to 16 fewer)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Multicentre study conducted across several countries, therefore not downgraded for indirectness Imprecision: Serious due to wide confidence interval consistent with the possibility for benefit and the possibility for no effect/trivial effect
1 trials Gottlieb RL, 2021 584 participants		Remdesivir 17 per 1,000 (6 - 46)	Standard Care/Placebo 62 per 1,000
WHO progression score (level 7 or above) D28	Outcome not yet measured or reported
WHO progression score (level 7 or above) D60	Outcome not yet measured or reported
All-cause mortality D28	RR: ( - )	Zero events in both groups		Low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Multicentre study conducted across several countries, therefore not downgraded for indirectness Imprecision: Very serious no events in both groups
1 trials Gottlieb RL, 2021 584 participants		Remdesivir 0 per 1,000 ( - )	Standard Care/Placebo 0 per 1,000
All-cause mortality D60	RR: 0.33 (0.01 - 8.15)	2 fewer per 1000 (from 3 fewer to 24 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Multicentre study conducted across several countries, therefore not downgraded for indirectness Imprecision: Serious due to wide confidence interval consistent with the possibility for no effect/trivial effect and the possibility for harm
1 trials Gottlieb RL, 2021 584 participants		Remdesivir 1 per 1,000 (0 - 28)	Standard Care/Placebo 3 per 1,000
Viral negative conversion D7	Outcome not yet measured or reported
Adverse events	RR: 0.90 (0.75 - 1.09)	45 fewer per 1000 (from 112 fewer to 40 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious We presume that the adverse event rates and the corresponding relative risks, are similar across diverse settings, therefore not downgraded for indirectness Imprecision: Serious due to wide confidence interval consistent with the possibility for benefit and the possibility for no effect/trivial effect
1 trials Gottlieb RL, 2021 584 participants		Remdesivir 404 per 1,000 (336 - 489)	Standard Care/Placebo 449 per 1,000
Serious adverse events	RR: 0.26 (0.10 - 0.70)	48 fewer per 1000 (from 59 fewer to 20 fewer)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious We presume that the adverse event rates and the corresponding relative risks, are similar across diverse settings, therefore not downgraded for indirectness Imprecision: Serious due to low number of participants/events
1 trials Gottlieb RL, 2021 584 participants		Remdesivir 17 per 1,000 (7 - 46)	Standard Care/Placebo 65 per 1,000

¹The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

Hospitalized patients

Forest plots
(last update: 2023-02-23)

Summary of findings
(last update: 2023-04-20)

Patient or population: COVID-19 patients
Setting: Worldwide
Intervention: Remdesivir
Comparison: Standard Care/Placebo

Outcome	Relative effect (95% CI)	Absolute effect (95% CI)¹		Certainty of the Evidence (GRADE)
Clinical improvement D28	RR: 1.04 (0.99 - 1.10)	28 more per 1000 (from 7 fewer to 71 more)		Low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns or high risk regarding adequate randomization, deviation from intended intervention, missing data, outcome measurement and selection of the reported results Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for benefit and the possibility for no effect/trivial effect
4 trials Spinner CD, 2020; Wang Y, 2020; Mahajan L, 2021; Ader F, 2021 1772 participants		Remdesivir 737 per 1,000 (701 - 779)	Standard Care/Placebo 709 per 1,000
Clinical improvement D60	Outcome not yet measured or reported
WHO progression score (level 7 or above) D28	RR: 0.71 (0.60 - 0.85)	52 fewer per 1000 (from 71 fewer to 27 fewer)		Low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding adequate randomisation, deviation from intended intervention, missing data and selection of reported results Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to low number of participants/events
5 trials Jittamala P, 2022; Beigel JH, 2020; Spinner CD, 2020; Wang Y, 2020; Mahajan L, 2021; Ader F, 2021 2970 participants		Remdesivir 126 per 1,000 (107 - 151)	Standard Care/Placebo 178 per 1,000	1 additional study was identified that assessed this outcome, but no results were reported.
WHO progression score (level 7 or above) D60	Outcome not yet measured or reported
All-cause mortality D28	RR: 0.91 (0.74 - 1.11)	10 fewer per 1000 (from 28 fewer to 12 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Despite some concerns with dequate randomization, deviation from intended intervention, missing data and selection of the reported results, not downgraded for risk of bias because the studies with these concerns contributed only a small proportion of the data Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious Imprecision downgraded by 1 level: due to wide confidence interval consistent with the possibility for benefit and the possibility for harm.
7 trials Jittamala P, 2022; Spinner CD 2020; Pan H, 2020; Beigel JH, 2020; Wang Y, 2020; Mahajan L, 2021; Barratt-Due A, 2021 7689 participants		Remdesivir 99 per 1,000 (81 - 121)	Standard Care/Placebo 109 per 1,000	1 additional study was identified that assessed this outcome, but no results were reported.
All-cause mortality D60	RR: 0.86 (0.72 - 1.03)	25 fewer per 1000 (from 51 fewer to 5 more)		Low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns or high risk regarding deviation from intended intervention, and missing data Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for benefit and the possibility for no effect/trivial effect
3 trials Barratt-Due A, 2021; Ali K, 2022; Ader F, 2022 2240 participants		Remdesivir 155 per 1,000 (130 - 186)	Standard Care/Placebo 181 per 1,000	1 additional study was identified that assessed this outcome, but no results were reported.
Viral negative conversion D7	RR: 1.06 (0.88 - 1.27)	16 more per 1000 (from 32 fewer to 73 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Despite some concerns with deviantion from intended intervetion and selection of the reported results not downgraded for risk of bias because the studies with these concerns contributed only a small proportion of weight to the effect estimate Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for benefit and the possibility for no effect/trivial effect
2 trials Wang Y, 2020; Ader F, 2021 1053 participants		Remdesivir 286 per 1,000 (237 - 343)	Standard Care/Placebo 270 per 1,000
Adverse events	RR: 1.01 (0.91 - 1.11)	6 more per 1000 (from 52 fewer to 64 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns due to deviation from intended intervention, outcome measurement and selection of the reported results. Inconsistency: Serious Inconsistency downgraded by 1 level: I²=:50.8% Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
4 trials Beigel JH, 2020; Spinner CD, 2020; Wang Y, 2020; Ader F, 2021 2752 participants		Remdesivir 587 per 1,000 (529 - 645)	Standard Care/Placebo 581 per 1,000
Serious adverse events	RR: 0.81 (0.62 - 1.05)	50 fewer per 1000 (from 100 fewer to 13 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding deviation from intended intervention, outcome measurement and selection of the reported results Inconsistency: Serious Inconsistency downgraded by 1 level: I²=:59.2% Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
5 trials Beigel JH, 2020; Spinner CD, 2020; Wang Y, 2020; Ader F, 2021 2888 participants		Remdesivir 213 per 1,000 (163 - 276)	Standard Care/Placebo 263 per 1,000	1 additional study was identified that assessed this outcome, but no results were reported.

¹The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: Confidence interval; RR: Risk ratio

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click here for Outpatients
click here for Hospitalized patients

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Permanent URL for this comparison: https://covid-nma.com/living_data/index.php?comparison=14

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Trial	Funding	Comparisons		Design	Participants	Sample size	Overall risk of bias Highest assessment	Full description
		Treatment 1	Treatment 2
NCT05041907 PLATCOV Jittamala P, medRxiv, 2022 Full text Commentary Commentary	Public/non profit	Remdesivir	Standard care	RCT	Patients with confirmed COVID-19 (mild) treated by 4 centers in Thailand (3 hospital sites) and Brazil (1 outpatient site)	N=136	Some concerns Details	Full description
NCT04330690 Ali K, CMAJ, 2022 Full text Commentary Commentary	Public/non profit	Remdesivir	Standard care	RCT	Patients with confirmed COVID-19 (mild-critical) admitted to 52 centers in Canada	N=1282	High Details	Full description
NCT04501952; EudraCT 2020-003510-12. Gottlieb RL, N Engl J Med, 2021 Full text Commentary Commentary	Private	Remdesivir	Placebo	RCT	Outpatients with confirmed COVID-19 (mild) treated at 64 centers in Denmark, Spain, UK and USA.	N=584	Some concerns Details	Full description
NCT04315948, EudraCT2020-000936-23 DisCoVeRy Ader F, Lancet Infect Dis, 2022 Full text Full text Full text Full text Commentary Commentary	Public/non profit	Remdesivir	Standard care	RCT	Patients with confirmed COVID-19 (mild-critical) admitted to 48 centers in France (39), Belgium (3), Portugal (2), Austria (3), and Luxembourg (1).	N=857	Some concerns Details	Full description
N/A Mahajan L, Indian J Anaesth, 2021 Full text Commentary	No specific funding	Remdesivir	Standard care	RCT	Patients with confirmed COVID-19 (moderate-severe) admitted to a single center in India.	N=82	High Details	Full description
ISRCTN83971151; NCT04315948 SOLIDARITY (RDV) Pan H, N Engl J Med, 2020 Full text Full text Commentary	Mixed	Remdesivir	Standard care	RCT	Patients with COVID-19 (mild-critical) admitted to 405 centers in 30 countries	N=5475	Low Details	Full description
NCT04292730 Spinner CD, JAMA, 2020 Full text Commentary	Private	Remdesivir Remdesivir 5 days	Standard care Remdesivir 10 days	RCT	Patients with COVID-19 (mild-severe) admitted to 105 centers in the USA, Europe and Asia	N=596	Some concerns Details	Full description
NCT04280705 Beigel JH, N Engl J Med, 2020 Full text Commentary	Mixed	Remdesivir	Placebo	RCT	Patients with confirmed COVID-19 (mild-critical) admitted to 60 centers in 10 countries	N=1062	Some concerns Details	Full description
NCT04257656 Wang Y, Lancet, 2020 Full text Commentary	Mixed	Remdesivir	Placebo	RCT	Patients with confirmed COVID-19 (severe) admitted to 10 centers in China	N=237	Some concerns Details	Full description
NCT04321616 NOR-SOLIDARITY Barratt-Due A, Ann Intern Med, 2021 Full text Full text Commentary	Mixed	Remdesivir	Standard care	RCT	Patients with confirmed COVID-19 (unclear severity) admitted to 23 centers in Norway	N=101	Low Details	Full description