A Meta-Analysis of Association between Remdesivir and Mortality among Critically-Ill COVID-19 Patients
1
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background: The World Health Organization guidelines did not make a recommendation on use of remdesivir based on disease severity. Little is known regarding effectiveness of remdesivir in critically ill coronavirus disease 2019 (COVID-19) patients. This has led to a state of dilemma for doctors leaving them skeptical of whether they should continue to recommend the drug or not. Materials and Methods: A systematic search adhering to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was conducted from inception until February 20, 2020. Electronic bibliographic databases (PubMed, Cochrane database, Scopus, Embase) were included. Using dichotomous data for select values, the unadjusted odds ratios (ORs) were calculated applying Mantel Haenszel (M-H) using random-effects model. The primary outcome of interest was all-cause mortality in ventilated and nonventilated patients. Results: The Remdesivir arm was associated with similar rates of 28-day all-cause mortality (OR: 0.93, 95% confidence interval [CI]: 0.80 - 1.08; P = 0.33). Remdesivir was not found to be favorable for ventilated patients. Non ventilated COVID-19 patients showed a significant lower in-hospital mortality rate as compared with patients requiring mechanical ventilatory support (OR: 6.86, 95% CI: 5.39 - 268.74; P <0.0001). Conclusion: Non-ventilated patients were associated with significant lower all-cause mortality rates. Prudent use of remdesivir is recommended in critically ill COVID-19 patients.
Abstract
Background: The World Health Organization guidelines did not make a recommendation on use of remdesivir based on disease severity. Little is known regarding effectiveness of remdesivir in critically ill coronavirus disease 2019 (COVID-19) patients. This has led to a state of dilemma for doctors leaving them skeptical of whether they should continue to recommend the drug or not. Materials and Methods: A systematic search adhering to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was conducted from inception until February 20, 2020. Electronic bibliographic databases (PubMed, Cochrane database, Scopus, Embase) were included. Using dichotomous data for select values, the unadjusted odds ratios (ORs) were calculated applying Mantel Haenszel (M-H) using random-effects model. The primary outcome of interest was all-cause mortality in ventilated and nonventilated patients. Results: The Remdesivir arm was associated with similar rates of 28-day all-cause mortality (OR: 0.93, 95% confidence interval [CI]: 0.80 - 1.08; P = 0.33). Remdesivir was not found to be favorable for ventilated patients. Non ventilated COVID-19 patients showed a significant lower in-hospital mortality rate as compared with patients requiring mechanical ventilatory support (OR: 6.86, 95% CI: 5.39 - 268.74; P <0.0001). Conclusion: Non-ventilated patients were associated with significant lower all-cause mortality rates. Prudent use of remdesivir is recommended in critically ill COVID-19 patients.
참고문헌 (13)
- Eastman RT, "Remdesivir: a review of its discovery and development leading to emergency use authorization for treatment of COVID-19", ACS Cent Sci, 6, pp.672~683 (2020)
- "Coronavirus (COVID-19) update: FDA issues emergency use authorization for potential COVID-19 treatment"[URL]
- WHO Solidarity Trial Consortium, "Repurposed antiviral drugs for Covid-19 - Interim WHO solidarity trial results", N Engl J Med, 384, pp.497~511 (2021)
- Moher D, "Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement", PLoS Med, 6, pp.e1000097~ (2009)
- Beigel JH, "Remdesivir for the treatment of Covid-19 - final report", N Engl J Med, 383, pp.1813~1826 (2020)
- Goldman JD, "Remdesivir for 5 or 10 days in patients with severe Covid-19", N Engl J Med, 383, pp.1827~1837 (2020)
- Grein J, "Compassionate use of remdesivir for patients with severe Covid-19", N Engl J Med, 382, pp.2327~2336 (2020)
- Wang Y, "Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial", Lancet, 395, pp.1569~1578 (2020)
- Lapadula G, "Remdesivir use in patients requiring mechanical ventilation due to COVID-19", Open Forum Infect Dis, 7, pp.ofaa481~ (2020)
- Qaseem A, "Should remdesivir be used for the treatment of patients with COVID-19? rapid, living practice points from the American College of Physicians (Version 2)", Ann Intern Med, 174, pp.673~679 (2021)
- "World's top intensive care body advises against remdesivir for sickest COVID patients"[URL]
- Mahajan L, "Clinical outcomes of using remdesivir in patients with moderate to severe COVID-19: A prospective randomised study", Indian J Anaesth, 65(Suppl 1), pp.S41~S46 (2021)