Major Update: Remdesivir for Adults With COVID-19 : A Living Systematic Review and Meta-analysis for the American College of Physicians Practice Points.

Autor:	Kaka AS; Minneapolis VA Health Care System and University of Minnesota School of Medicine, Minneapolis, Minnesota (A.S.K., W.D., T.J.W.)., MacDonald R; Minneapolis VA Health Care System, Minneapolis, Minnesota (R.M., N.G.)., Greer N; Minneapolis VA Health Care System, Minneapolis, Minnesota (R.M., N.G.)., Vela K; VA Portland Health Care System, Portland, Oregon (K.V., A.O.)., Duan-Porter W; Minneapolis VA Health Care System and University of Minnesota School of Medicine, Minneapolis, Minnesota (A.S.K., W.D., T.J.W.)., Obley A; VA Portland Health Care System, Portland, Oregon (K.V., A.O.)., Wilt TJ; Minneapolis VA Health Care System and University of Minnesota School of Medicine, Minneapolis, Minnesota (A.S.K., W.D., T.J.W.).
Jazyk:	angličtina
Zdroj:	Annals of internal medicine [Ann Intern Med] 2021 May; Vol. 174 (5), pp. 663-672. Date of Electronic Publication: 2021 Feb 09.
DOI:	10.7326/M20-8148
Abstrakt:	Background: Remdesivir is being studied and used for treatment of coronavirus disease 2019 (COVID-19). Purpose: To 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 Sources: Several sources from 1 January 2020 through 7 December 2020. Study Selection: English-language, randomized controlled trials (RCTs) of remdesivir for COVID-19. New evidence is incorporated by using living review methods. Data Extraction: 1 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 Synthesis: The 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. Limitation: Summarizing findings was challenging because of varying disease severity definitions and outcomes. Conclusion: In 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 Source: U.S. Department of Veterans Affairs.
Databáze:	MEDLINE
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