Essy Mozaffari, Aastha Chandak, Zhiji Zhang, Shuting Liang, Mark Thrun, MD Robert L Gottlieb, Daniel R Kuritzkes, Paul E Sax, David A Wohl, Roman Casciano, Paul Hodgkins, Richard Haubrich
doi:10.1093/cid/ciab875/6378778
Background: Remdesivir (RDV) improved clinical outcomes among hospitalized COVID-19 patients in randomized trials, but data from clinical practice are limited.
Methods: We examined survival outcomes for US patients hospitalized with COVID-19 between Aug-Nov 2020 and treated with RDV within two-days of hospitalization vs. those not receiving RDV during their hospitalization using the Premier Healthcare Database. Preferential within-hospital propensity score matching with replacement was used. Additionally, patients were also matched on baseline oxygenation level (no supplemental oxygen charges (NSO), low-flow oxygen (LFO), high-flow oxygen/non-invasive ventilation (HFO/NIV) and invasive mechanical ventilation/ECMO (IMV/ECMO) and two-month admission window and excluded if discharged within 3-days of admission (to exclude anticipated discharges/transfers within 72-hrs consistent with ACTT-1 study). Cox Proportional Hazards models were used to assess time to 14-/28-day mortality overall and for patients on NSO, LFO, HFO/NIV and IMV/ECMO. Results: 28,855 RDV patients were matched to 16,687 unique non-RDV patients. Overall, 10.6% and 15.4% RDV patients died within 14-and 28-days, respectively compared with 15.4% and 19.1% non-RDV patients. Overall, RDV was associated with a reduction in mortality at 14-days (HR[95% CI]: 0.76*0.70−0.83+) and 28-days (0.89*0.82−0.96+). This mortality benefit was also seen for NSO, LFO and IMV/ECMO at 14-days (NSO:0.69*0.57−0.83+, LFO:0.68*0.80−0.77+, IMV/ECMO:0.70*0.58−0.84+) and 28-days (NSO:0.80*0.68−0.94+, LFO:0.77*0.68−0.86+, IMV/ECMO:0.81*0.69−0.94+). Additionally, HFO/NIV RDV group had a lower risk of mortality at 14-days (0.81*0.70−0.93+) but no statistical significance at 28-days.
References
Acosta, Mathis, Budnitz, Geller, Chai et al., COVID-19
Al-Abdouh, Bizanti, Barbarawi, Jabri, Kumar et al., Remdesivir for the treatment of COVID-19: A systematic review and meta-analysis of randomized controlled trials, Contemp Clin Trials
Beigel, Tomashek, Dodd, Mehta, Zingman et al., Remdesivir for the Treatment of Covid-19 -Final Report, N Engl J Med
Buckley, Wohlford, Ting, Alahmed, Van Tassell et al., Role for Anti-Cytokine Therapies in Severe Coronavirus Disease 2019, Crit Care Explor
Elsawah, Elsokary, Abdallah, Elshafie, Efficacy and safety of remdesivir in hospitalized Covid-19 patients: Systematic review and meta-analysis including network metaanalysis, Rev Med Virol
Falcão, Viegas, Carmo, Soares, Falcao et al., A prospective, observational study to evaluate adverse drug reactions in patients with COVID-19 treated with remdesivir or hydroxychloroquine: a preliminary report, Eur J Hosp Pharm
Garibaldi, Wang, Robinson, Zeger, Bandeen-Roche et al., Comparison of Time to Clinical Improvement With vs Without Remdesivir Treatment in Hospitalized Patients With COVID-19, JAMA Netw Open
Garibaldi, Wang, Robinson, Zeger, Roche et al., Effectiveness of remdesivir with and without dexamethasone in hospitalized patients with COVID-19, medRxiv
Gilead, Remdesivir (Veklury) package insert
Goldman, Lye, Hui, Marks, Bruno et al., or 10, Remdesivir for
Gottlieb, A Neutralizing Monoclonal Antibody for Hospitalized Patients with Covid-19, N Engl J Med
Group, Horby, Lim, Emberson, Mafham et al., Dexamethasone in Hospitalized Patients with Covid-19, N Engl J Med
Kadri, Gundrum, Warner, Cao, Babiker et al., Uptake and Accuracy of the Diagnosis Code for COVID-19 Among US Hospitalizations, JAMA
Kaka, Macdonald, Greer, Vela, Duan-Porter et al., Major Update: Remdesivir for Adults With COVID-19 : A Living Systematic Review and Meta-analysis for the American College of Physicians Practice Points, Ann Intern Med
Kalligeros, Tashima, Mylona, Rybak, Flanigan et al., Remdesivir Use Compared With Supportive Care in Hospitalized Patients With Severe COVID-19: A Single-Center Experience, Open Forum Infect Dis
Lai, Chen, Wang, Chen, Wang et al., Clinical efficacy and safety of remdesivir in patients with COVID-19: a systematic review and network meta-analysis of randomized controlled trials, J Antimicrob Chemother
Lapadula, Bernasconi, Bellani, Soria, Rona et al., Remdesivir Use in Patients Requiring Mechanical Ventilation due to COVID-19, Open Forum Infect Dis
Li, Zhang, Hu, Tong, Zheng et al., Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients With Severe and Life-threatening COVID-19: A Randomized Clinical Trial, JAMA
Ly-Cov555 Study, Group, Lundgren, Grund, Barkauskas et al., None
Morris, Jüni, Odutayo, Remdesivir for hospitalized patients with COVID-19, Science Briefs of the Ontario COVID-19 Science Advisory Table
Olender, Perez, Go, Balani, Eg et al., Remdesivir for Severe COVID-19 versus a Cohort Receiving Standard of Care, Clin Infect Dis
Olender, Walunas, Martinez, Perez, Castagna et al., Remdesivir versus Standard-of-Care for Severe Coronavirus Disease
Pasquini, Montalti, Temperoni, Canovari, Mancini et al., Effectiveness of remdesivir in patients with COVID-19 under mechanical ventilation in an Italian ICU, J Antimicrob Chemother
Rubin, Chan-Tack, Farley, Sherwat, FDA Approval of Remdesivir -A Step in the Right Direction, N Engl J Med
Simonovich, Pratx, Scibona, Beruto, Vallone et al., A Randomized Trial of Convalescent Plasma in Covid-19 Severe Pneumonia, N Engl J Med
Spinner, Gottlieb, Criner, Lopez, Cattelan et al., Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19: A Randomized Clinical Trial, JAMA
Stone, Frigault, Serling-Boyd, Fernandes, Harvey et al., Efficacy of Tocilizumab in Patients Hospitalized with Covid-19, N Engl J Med
Wise, Covid-19: Remdesivir is recommended for authorisation by European Medicines Agency, BMJ
