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Remdesivir: A potential game-changer or just a myth? A Systematic Review and Meta-analysis
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  • Dhan Shrestha,
  • Pravash Budhathoki,
  • Nawazish-i-Husain Syed,
  • Era Rawal,
  • Sumit Raut,
  • Sitaram Khadka
Dhan Shrestha
Mangalbare Hospital, Morang
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Pravash Budhathoki
Dr Iwamura Memorial Hospital
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Nawazish-i-Husain Syed
University of the Punjab
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Era Rawal
Kathmandu Medical College
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Sumit Raut
Kathmandu Medical College and Teaching Hospital
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Sitaram Khadka
Shree Birendra Hospital
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Abstract

Aim COVID-19 outbreak spread all over the world and created a public health catastrophe. Here, we have aimed to conduct a systematic review and meta-analysis on remdesivir use for COVID-19. Methods We searched Pubmed, Pubmed Central, Scopus, Embase, clinicaltrials.gov, and preprint sites and identified ten studies for qualitative and four studies for quantitative analysis using PRISMA guidelines. The quantitative synthesis was performed using fixed and random effect models in RevMan 5.4. Heterogeneity was assessed using the I-squared (I2) test. Results Comparing remdesivir group with placebo or standard of care (SOC) group, remdesivir reduces 14 days mortality (OR 0.61, CI 0.41- 0.91), need of mechanical ventilation (OR 0.73, CI 0.54-0.97), and overall severe adverse effects (OR 0.69, 95% CI 0.54 to 0.88). There is better clinical improvement on day 28 (OR 1.59, CI 1.06- 2.39); day 14 clinical recovery (OR 1.48, CI 1.19-1.84); day 14 discharge rate (OR 1.41, CI 1.15-1.73) among remdesivir groups. Earlier clinical improvement (MD -2.51, CI -4.16 to -0.85); and clinical recovery (MD -4.69, CI -5.11 to -4.28) seen among remdesivir group. While no difference on 28 days mortality rate; discharge rate; overall adverse effect. Longer course (10 days) of remdesivir showed higher discharge rate at day 14 (OR 2.11, CI 1.50-2.97), but there are significantly higher rates of serious adverse effects, and drug discontinuation than the shorter course. Conclusion Remdesivir showed a better 14 days mortality profile, clinical recovery, and discharge rate. Overall clinical improvement and clinical recovery were earlier among remdesivir group.