Effectiveness of remdesivir with and without dexamethasone in hospitalized patients with COVID-19
MD MEHP Brian T Garibaldi, MS Kunbo Wang, MD Matthew L Robinson, PhD Scott L Zeger, PhD Karen Bandeen Roche, PhD Mei-Cheng Wang, MD G Caleb Alexander, MD Amita Gupta, MD MPH Robert Bollinger, PhD Yanxun Xu
doi:10.1101/2020.11.19.20234153
Rationale: Remdesivir and dexamethasone reduced the severity of COVID-19 in clinical trials. However, their individual or combined effectiveness in clinical practice remains unknown.
Objectives: To examine the effectiveness of remdesivir with or without dexamethasone.
Methods: We conducted a multicenter, retrospective cohort study between March 4 and August 29, 2020. Eligible COVID cases were hospitalized patients treated with remdesivir with or without dexamethasone. We applied a Cox proportional hazards model with propensity score matching to estimate the effect of these treatments on clinical improvement by 28 days (discharge or a 2-point decrease in WHO severity score) and 28-day mortality.
Measurements and Main Results: Of 2485 COVID-19 patients admitted between March 4 and August 29, 2020, 342 received remdesivir and 157 received remdesivir plus dexamethasone. Median age was 60 years; 45% were female; 81% were non-white. Remdesivir recipients on room air or nasal cannula oxygen had a faster time to clinical improvement (median 5.0 days [IQR 4.0, 8.0], remdesivir vs. 7.0 days [IQR 5.0, 12.0], control; adjusted hazard ratio (aHR) 1.55 [1.28; 1.87]), yet those requiring higher levels of respiratory support did not benefit. Remdesivir recipients had lower, but statistically insignificant, 28-day mortality (7.6% [23 deaths], remdesivir vs. 14.9% [45 deaths], control). Adding dexamethasone trended toward lower 28-day mortality compared to remdesivir alone (5.1% [8 deaths] vs. 9.2% [17 deaths]; aHR 0.14 [0.02;
1.03]). Conclusions: Remdesivir offered a significantly faster time to clinical improvement among a cohort of predominantly non-white patients hospitalized with COVID-19, particularly with mildmoderate disease. Remdesivir plus dexamethasone may reduce mortality.
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