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The following is a summary of “A systematic review and meta-analysis of the effectiveness of remdesivir to treat SARS-CoV-2 infection in hospitalized patients: have the guidelines evolved with the evidence?,” published in the March 2025 issue of Clinical Infectious Diseases by Bartoletti et al. 

As understanding of SARS-CoV-2 evolved, treatment guidelines included remdesivir (RDV), highlighting the need to integrate clinical trials and real-world evidence.  

Researchers conducted a retrospective study using a systematic literature review (SLR) and meta-analysis (MA) to evaluate RDV effectiveness in adults who were hospitalized.  

They searched MEDLINE, Embase, and Cochrane Library databases for interventional and observational studies on RDV efficacy. A double-reviewer process was applied for source selection, screening, data extraction, and risk of bias assessment. A hierarchical random-effects model MA was conducted, with subgroup analyses for randomized controlled trials (RCT) and real-world (RW) studies.  

The results showed that from January 2019 to December 2023, over 18,000 sources were screened, identifying 122 unique studies with 25,174 participants in RCTs and 12,798,59 in RW studies and RDV significantly improved survival in the overall population (OR: 0.69 (0.55-0.86); P=0.001) across SARS-CoV-2 variants and disease severities: no supplemental oxygen [OR: 0.81 (0.75-0.88)], low-flow oxygen [OR: 0.71 (0.64-0.79)], high-flow oxygen [OR: 0.87 (0.83-0.91)], and invasive mechanical ventilation [OR: 0.78 (0.68-0.90)]. The rehospitalization risk was lower with RDV treatment [OR: 0.72 (0.64-0.81)].  

Investigators concluded that RDV improved survival in patients with SARS-CoV-2 who were hospitalized across all severity levels, emphasizing the need for guidelines to incorporate both RCTs and RW data. 

Source: academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaf111/8069779