Remdesivir for the treatment of COVID‐19

Background Remdesivir is an antiviral medicine approved for the treatment of mild‐to‐moderate coronavirus disease 2019 (COVID‐19). This led to widespread implementation, although the available evidence remains inconsistent. This update aims to fill current knowledge gaps by identifying, describing, evaluating, and synthesising all evidence from randomised controlled trials (RCTs) on the effects of remdesivir on clinical outcomes in COVID‐19. Objectives To assess the effects of remdesivir and standard care compared to standard care plus/minus placebo on clinical outcomes in patients treated for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Search methods We searched the Cochrane COVID‐19 Study Register (which comprises the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, ClinicalTrials.gov, World Health Organization (WHO) International Clinical Trials Registry Platform, and medRxiv) as well as Web of Science (Science Citation Index Expanded and Emerging Sources Citation Index) and WHO COVID‐19 Global literature on coronavirus disease to identify completed and ongoing studies, without language restrictions. We conducted the searches on 31 May 2022. Selection criteria We followed standard Cochrane methodology. We included RCTs evaluating remdesivir and standard care for the treatment of SARS‐CoV‐2 infection compared to standard care plus/minus placebo irrespective of disease severity, gender, ethnicity, or setting. We excluded studies that evaluated remdesivir for the treatment of other coronavirus diseases. Data collection and analysis We followed standard Cochrane methodology. To assess risk of bias in included studies, we used the Cochrane RoB 2 tool for RCTs. We rated the certainty of evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach for outcomes that were reported according to our prioritised categories: all‐cause mortality, in‐hospital mortality, clinical improvement (being alive and ready for discharge up to day 28) or worsening (new need for invasive mechanical ventilation or death up to day 28), quality of life, serious adverse events, and adverse events (any grade). We differentiated between non‐hospitalised individuals with asymptomatic SARS‐CoV‐2 infection or mild COVID‐19 and hospitalised individuals with moderate to severe COVID‐19. Main results We included nine RCTs with 11,218 participants diagnosed with SARS‐CoV‐2 infection and a mean age o