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79 remdesivir COVID-19 controlled studies, 12 RCTs
2% improvement
for early treatment, RR
0.98
[0.55-1.75]
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Madan (ES)
66%
0.34 [0.12-0.96]
death
4/112
27/260
Improvement, RR [CI]
Treatment
Control
PINETREE
Gottlieb (DB RCT)
87%
0.13 [0.03-0.59]
death/hosp.
2/279
15/283
PINETREE
Gottlieb (DB RCT)
72%
0.28 [0.11-0.75]
hosp.
5/279
18/283
PINETREE
Gottlieb (DB RCT)
29%
0.71 [0.37-1.37]
no recov.
43/66
45/60
PINETREE
Gottlieb (DB RCT)
48%
0.52 [0.34-0.79]
no recov.
108/169
132/165
Killingley
-60%
1.60 [0.51-5.03]
progression
6 (n)
12 (n)
Piccicacco
66%
0.34 [0.01-8.32]
death
0/82
1/90
Piccicacco
30%
0.70 [0.28-1.72]
hosp.
7/82
11/90
Piccicacco
52%
0.48 [0.21-0.96]
hosp./ER
9/82
21/90
Piccicacco
78%
0.22 [0.05-0.97]
progression
2/82
10/90
Kneidinger
20%
0.80 [0.35-1.82]
severe case
6/46
28/172
Ong
-75%
1.75 [0.23-13.0]
recov. time
4 (n)
14 (n)
Ong
-56%
1.56 [0.67-3.60]
hosp. time
4 (n)
14 (n)
Ong
-61%
1.61 [0.86-3.00]
viral time
4 (n)
14 (n)
Chew
-68%
1.68 [0.51-5.58]
progression
12 (n)
151 (n)
PLATCOV
Jittamala (RCT)
66%
0.34 [0.01-8.12]
hosp.
0/67
1/69
PLATCOV
Jittamala (RCT)
29%
0.71 [0.61-0.83]
viral rate
67 (n)
69 (n)
Seah
-129%
2.29 [0.26-20.1]
no recov.
2/7
1/8
Choi
-267%
3.67 [0.20-3.27]
death
308 (n)
13,656 (n)
Choi
-600%
7.00 [4.00-11.5]
ICU
308 (n)
13,656 (n)
Choi
-686%
7.86 [6.40-9.40]
oxygen
308 (n)
13,656 (n)
Choi
-182%
2.82 [2.35-3.33]
misc.
308 (n)
13,656 (n)
Siami
-70%
1.70 [0.76-3.82]
hosp.
341 (n)
148 (n)
Wang (RCT)
-9%
1.09 [0.54-2.18]
death
22/158
10/78
Wang (RCT)
24%
0.76 [0.29-1.95]
death
8/71
7/47
Wang (RCT)
-48%
1.48 [0.45-4.88]
death
12/84
3/31
Olender
59%
0.41 [0.24-0.71]
death
24/312
102/818
Spinner (RCT)
35%
0.65 [0.18-2.40]
death
5/384
4/200
Pasquini (ICU)
16%
0.84 [0.69-0.94]
death
14/25
24/26
ICU patients
Fried
61%
0.39 [0.15-0.99]
death
4/48
2,510/11,673
Fried
-37%
1.37 [0.81-2.30]
ventilation
11/48
1,956/11,673
Beigel (RCT)
27%
0.73 [0.52-1.03]
death
541 (n)
521 (n)
Beigel (RCT)
45%
0.55 [0.36-0.83]
death
541 (n)
521 (n)
Beigel (RCT)
22%
0.78 [0.67-0.89]
no recov.
541 (n)
521 (n)
SOLIDARITY
SOLIDARITY .. (RCT)
5%
0.95 [0.81-1.11]
death
301/2,743
303/2,708
El-Solh
29%
0.71 [0.52-0.97]
death
63/219
202/424
SARSTer
Flisiak
49%
0.51 [0.19-1.30]
death
5/122
17/211
SARSTer
Flisiak
58%
0.42 [0.13-1.18]
death
4/82
14/119
SARSTer
Flisiak
56%
0.44 [0.21-0.86]
no improv.
9/122
36/211
Garibaldi
20%
0.80 [0.46-1.41]
death
23/303
45/303
Garibaldi
35%
0.65 [0.53-0.78]
no improv.
52/303
80/303
Ullah
-100%
2.00 [0.67-5.94]
death
8/30
4/30
Ullah
-250%
3.50 [0.79-15.5]
ventilation
7/30
2/30
Yeramaneni
-24%
1.24 [0.11-14.2]
death
32 (n)
7,126 (n)
Goldberg
9%
0.91 [0.50-1.67]
hosp. time
29 (n)
113 (n)
Goldberg
0%
1.00 [0.92-1.09]
viral+
29 (n)
113 (n)
Tsuzuki
-4%
1.04 [0.98-1.09]
death
69/824
285/11,663
Tsuzuki
2%
0.98 [0.91-1.07]
ventilation
48/824
98/11,663
Tsuzuki
15%
0.85 [0.41-1.77]
progression
559/824
1,784/11,663
Mahajan (RCT)
-76%
1.76 [0.46-6.82]
death
5/34
3/36
Mahajan (RCT)
-112%
2.12 [0.41-10.8]
ventilation
4/34
2/36
Mulhem
-86%
1.86 [0.21-5.24]
death
1/8
515/3,211
Haji Aghajani
19%
0.81 [0.46-1.46]
death
46 (n)
945 (n)
Elhadi (ICU)
-11%
1.11 [0.81-1.51]
death
14/21
267/444
ICU patients
Pourhoseingholi
-2%
1.02 [0.72-1.44]
death
42/123
297/2,345
Arch (PSM)
20%
0.80 [0.64-0.98]
death
203/1,491
777/4,676
Arch (PSM)
18%
0.82 [0.63-1.06]
death
140/1,502
565/4,728
Arch (PSM)
-68%
1.68 [1.19-2.34]
ventilation
106/1,498
153/4,602
Barrat-Due (DB RCT)
0%
1.00 [0.20-4.60]
death
3/42
4/57
Barrat-Due (DB RCT)
-36%
1.36 [0.29-6.39]
death
3/42
3/57
Barrat-Due (DB RCT)
55%
0.45 [0.05-4.20]
death
1/42
3/57
Barrat-Due (DB RCT)
-47%
1.47 [1.10-1.98]
no recov.
42 (n)
76 (n)
Barrat-Due (DB RCT)
-43%
1.43 [1.09-1.87]
no recov.
42 (n)
76 (n)
Barrat-Due (DB RCT)
-24%
1.24 [0.96-1.60]
no recov.
42 (n)
76 (n)
Barrat-Due (DB RCT)
-50%
1.50 [1.01-2.23]
no recov.
42 (n)
76 (n)
Ohl (PSM)
-6%
1.06 [0.83-1.36]
death
143/1,172
124/1,172
Ohl (PSM)
-100%
2.00 [1.33-3.02]
hosp. time
1,172 (n)
1,172 (n)
Madan
44%
0.56 [0.33-0.95]
death
23/398
27/260
Madan
66%
0.34 [0.12-0.96]
death
4/112
27/260
Madan
62%
0.38 [0.18-0.80]
death
9/226
27/260
Madan
-60%
1.60 [0.82-3.13]
death
10/60
27/260
Madan
31%
0.69 [0.37-1.29]
death
19/398
18/260
Madan
35%
0.65 [0.32-1.35]
death
14/398
14/260
Madan
48%
0.52 [0.21-1.31]
death
8/398
10/260
Madan
35%
0.65 [0.19-2.23]
death
5/398
5/260
Madan
13%
0.87 [0.20-3.86]
death
4/398
3/260
Kuno (PSM)
1%
0.99 [0.84-1.17]
death
214/999
216/999
Kuno (PSM)
0%
1.00 [0.80-1.24]
ventilation
140/999
140/999
Kuno (PSM)
-17%
1.17 [1.00-1.37]
ICU
260/999
222/999
Elavarasi
-137%
2.37 [1.98-2.83]
death
146/403
207/1,352
Diaz
35%
0.65 [0.46-0.92]
death
33/286
173/852
Diaz
44%
0.56 [0.32-0.97]
death
286 (n)
852 (n)
DISCOVERY
Ader (RCT)
6%
0.94 [0.59-1.45]
death
34/414
37/418
DISCOVERY
Ader (RCT)
12%
0.88 [0.50-1.56]
death
21/414
24/418
DISCOVERY
Ader (RCT)
10%
0.90 [0.70-1.15]
7-point status
414 (n)
418 (n)
DISCOVERY
Ader (RCT)
-2%
1.02 [0.80-1.30]
7-point status
414 (n)
418 (n)
Mozaffari
12%
0.88 [0.81-0.96]
death
4,441/28,855
5,499/28,855
Mozaffari
24%
0.76 [0.69-0.83]
death
3,057/28,855
4,437/28,855
Schmidt (PSM)
-509%
6.09 [2.71-13.7]
severe case
43 (n)
434 (n)
Jamir (ICU)
8%
0.92 [0.55-1.55]
death
60/181
41/85
ICU patients
Mustafa
33%
0.67 [0.38-1.20]
death
16/200
29/244
CATCO
Ali (RCT)
12%
0.88 [0.72-1.07]
death
127/634
152/647
CATCO
Ali (RCT)
17%
0.83 [0.67-1.03]
death
117/634
145/647
CATCO
Ali (RCT)
21%
0.79 [0.40-1.58]
death
14/634
18/647
CATCO
Ali (RCT)
47%
0.53 [0.38-0.75]
ventilation
46/634
89/647
CATCO
Ali (RCT)
9%
0.91 [0.73-1.14]
no recov.
634 (n)
647 (n)
CATCO
Ali (RCT)
-11%
1.11 [1.01-1.23]
hosp. time
634 (n)
647 (n)
Kurniyanto
-460%
5.60 [2.32-13.5]
death
7/45
12/432
Siraj
53%
0.47 [0.35-0.62]
death
108/413
197/587
Salehi (ICU)
37%
0.63 [0.43-0.94]
death
17/40
57/85
ICU patients
Elec
19%
0.81 [0.38-1.69]
death
7/38
29/127
Elec
11%
0.89 [0.45-1.78]
ventilation
8/38
30/127
Elec
-72%
1.72 [1.11-2.66]
ICU
18/38
35/127
Zangeneh (ICU)
32%
0.68 [0.45-1.01]
death
n/a
n/a
ICU patients
Malundo
-17%
1.17 [0.80-1.70]
death
24/115
197/1,100
Bowen
-57%
1.57 [1.25-1.97]
death
817 (n)
3,814 (n)
Raad
42%
0.58 [0.39-0.88]
death
n/a
n/a
Oku
-40%
1.40 [0.41-4.36]
death
3/46
8/172
Behboodikhah
38%
0.62 [0.30-1.30]
death
1,214 (n)
960 (n)
Cacho
-80%
1.80 [0.37-8.82]
death
5/57
2/41
Cacho
-44%
1.44 [0.53-3.89]
severe case
10/57
5/41
Cacho
-73%
1.73 [0.93-3.21]
m/s case
24/57
10/41
Cacho
-92%
1.92 [0.54-6.79]
no disch.
8/57
3/41
Hartantri
11%
0.89 [0.31-2.53]
death
n/a
n/a
Hartantri
24%
0.76 [0.33-1.77]
death
n/a
n/a
Alshamrani (PSM)
17%
0.83 [0.72-0.93]
death
137/246
725/1,078
Alshamrani (PSM)
4%
0.96 [0.90-1.00]
progression
215/246
984/1,078
Alshamrani (PSM)
-43%
1.43 [1.13-1.80]
ICU
245 (n)
995 (n)
Alshamrani (PSM)
7%
0.93 [0.81-1.05]
hosp. time
246 (n)
1,078 (n)
Mitsushima
-44%
1.44 [1.09-1.90]
death
n/a
n/a
Punzalan
-42%
1.42 [0.92-2.20]
death
47/224
26/176
Punzalan
-59%
1.59 [1.19-2.13]
progression
93/224
46/176
Kim
-1612%
17.12 [0.19-1565]
death
14/145
0/22
Aweimer
-13%
1.13 [0.93-1.37]
death
40/51
68/98
Intubated patients
Arfijanto
1%
0.99 [0.64-1.53]
viral+
17/44
46/118
Bavaro (PSW)
7%
0.93 [0.89-0.97]
severe case
120 (n)
211 (n)
Shamsi
-23%
1.23 [0.56-2.69]
death
8/53
16/130
Mozaffari (PSM)
25%
0.75 [0.68-0.83]
death
14,169 (n)
5,341 (n)
Mozaffari (PSM)
30%
0.70 [0.62-0.78]
death
14,169 (n)
5,341 (n)
Nadeem
-12%
1.12 [0.39-3.26]
death
12/96
4/36
Burhan (ICU)
-15%
1.15 [0.96-1.37]
death
33/43
345/516
ICU patients
Hagman
0%
1.00 [0.60-1.80]
death
105 (n)
213 (n)
Hagman
0%
1.00 [0.50-1.90]
death
105 (n)
213 (n)
Hagman
20%
0.80 [0.30-2.40]
death
105 (n)
213 (n)
Hagman
-40%
1.40 [0.80-2.40]
progression
105 (n)
213 (n)
Hagman
29%
0.71 [0.50-1.11]
viral+
105 (n)
213 (n)
Ho
-62%
1.62 [1.35-1.95]
death
5,294 (n)
21,151 (n)
Amirizadeh (ICU)
-3%
1.03 [0.86-1.24]
death
31/35
30/35
ICU patients
Amirizadeh (ICU)
-52%
1.52 [0.83-2.78]
ventilation time
35 (n)
35 (n)
ICU patients
Amirizadeh (ICU)
-27%
1.27 [0.86-1.88]
ICU
35 (n)
35 (n)
ICU patients
Amirizadeh (ICU)
-24%
1.24 [0.88-1.75]
hosp. time
35 (n)
35 (n)
ICU patients
Muntean
-45%
1.45 [1.04-2.03]
death
71/287
45/264
Chang
-185%
2.85 [1.03-7.85]
death
81 (n)
81 (n)
Alsaraj (RCT)
-83%
1.83 [0.66-5.11]
death
9/52
5/53
Liao
-25%
1.25 [0.55-2.86]
death
37/59
3/6
Sokolski
0%
1.00 [0.67-1.47]
death
88 (n)
460 (n)
Lewandowski
-21%
1.21 [0.66-2.22]
death
430 (all patients)
Drouin
-46%
1.46 [1.15-1.54]
severe case
52/102
135/354
Milan
-34%
1.34 [0.20-8.91]
death
1/8
16/172
Milan
-122%
2.22 [0.86-5.78]
ventilation
3/8
29/172
Milan
-419%
5.19 [3.40-7.92]
ICU
7/8
29/172
REDPINE
Sise (DB RCT)
-0%
1.00 [0.67-1.49]
death
51/163
25/80
REDPINE
Sise (DB RCT)
17%
0.83 [0.50-1.39]
death
41/163
23/80
REDPINE
Sise (DB RCT)
18%
0.82 [0.50-1.32]
death/int.
48/163
26/80
REDPINE
Sise (DB RCT)
16%
0.84 [0.52-1.38]
misc.
163 (n)
80 (n)
REDPINE
Sise (DB RCT)
-5%
1.05 [0.64-1.72]
misc.
163 (n)
80 (n)
Anzalone (PSM)
-33%
1.33 [1.29-1.37]
death
n/a
n/a
Anzalone (PSM)
8%
0.92 [0.89-0.96]
ventilation
n/a
n/a
Kawther
-9%
1.09 [0.46-2.57]
death
111 (n)
340 (n)
Remdesivir COVID-19 outcomes
c19 early .org
December 2024
Favors remdesivir
Favors control
Figure S2. Comparison of results for RCTs versus observational studies.
For COVID-19 treatments, there is no significant difference between the results of RCTs and observational studies. Observational studies do not systematically over or underestimate efficacy. For high-cost treatments, there is a non-significant trend towards RCTs showing greater efficacy.
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