GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
Explanations:
a. ACTT Beigel 2020, Wang 2020
b. Not downgraded for indirectness: Wang 2020 and ACCT Beigel 2020 included similar proportions of patients with severe disease and the incidence of adverse events was unlikely to have been confounded by severity.
c. Downgraded by two levels for very serious imprecision; the number of events were few and the 95% CI of the effect estimate included clinically important reductions and increases in thrombotic events with Remdesivir.
d. Downgraded by one level for serious inconsistency; the I2 is 65%
e. Downgraded by one level for serious imprecision: The number of events were few and the 95% CI of the effect estimate included a substantial reduction as well as a modest increase in the incidence of infections with Remdesivir compared to placebo/SOC.
f. Wang 2020, Spinner 2020
g. Downgraded by one level for serious risk of bias; Spinner 2020 was judged to be at high risk of bias and contributed 56.5 % of weight in the meta-analysis
h. ACTT Beigel 2020 , Wang 2020, Spinner 2020
i. Downgraded by one level serious inconsistency; as I2 is 76%
j. Downgraded by two levels very serious imprecision; the 95% CI is very wide