Remdesivir and Systemic Corticosteroids for the Treatment of COVID-19: A Bayesian Reanalysis

Lee, Todd C.; McDonald, Emily G.; Butler-Laporte, Guillaume; Harrison, Luke B.; Cheng, Matthew P.; Brophy, James M.

Importance The worldwide death toll from COVID-19 has surpassed 2 million and treatments that decrease mortality are urgently needed. Objective To examine the probability of mortality benefit for remdesivir and contrast with systemic corticosteroids. Design, setting, and participants A probabilistic reanalysis of available clinical trial data for corticosteroids or remdesivir in the treatment of hospitalized patients with COVID-19 using a Bayesian random effects meta-analytic approach. Studies were identified from existing meta-analyses performed by the World Health Organization. Main outcomes and measures For both drugs, we calculated the posterior probabilities of an absolute decrease in mortality versus control patients by subgroups based on oxygen requirements. To contextualize, we quantified the probability of at least a 1, 2, or 5% absolute mortality decrease. Results Among patients requiring ventilation, remdesivir had only a 4% probability of 1% or greater mortality benefit compared to 93% for corticosteroids. For patients requiring supplemental oxygen, the probability of 1% or greater survival benefit was 81% for remdesivir compared to 93% for dexamethasone. Finally, for patients without oxygen requirements, the probabilities of 1% or greater mortality benefit were 29% for remdesivir and 4% for dexamethasone. Conclusions and relevance Using a Bayesian analytic approach, remdesivir had a low probability of achieving a clinically meaningful reduction in mortality, except for patients requiring supplemental oxygen. Corticosteroids were more promising for populations requiring oxygen support, especially ventilation. While awaiting more definitive studies, this probabilistic interpretation of the evidence will help guide treatment decisions for clinicians as well as guideline and policy makers.