tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2024 Apr 16;11(6)
fae202.
doi: 10.1093/ofid/ofae202. eCollection 2024 Jun. Remdesivir is Associated with Reduced Mortality in Patients Hospitalized for COVID-19 Not Requiring Supplemental Oxygen
Essy Mozaffari[SUP] 1 [/SUP], Aastha Chandak[SUP] 2 [/SUP], Chidinma Chima-Melton[SUP] 3 [/SUP], Andre C Kalil[SUP] 4 [/SUP], Heng Jiang[SUP] 5 [/SUP], EunYoung Lee[SUP] 1 [/SUP], Celine Der-Torossian[SUP] 1 [/SUP], Mark Thrun[SUP] 1 [/SUP], Mark Berry[SUP] 1 [/SUP], Richard Haubrich[SUP] 1 [/SUP], Robert L Gottlieb[SUP] 6 7 8 9 [/SUP]
Affiliations
Background: Remdesivir has demonstrated benefit in some hospitalized patients with coronavirus disease 2019 (COVID-19) on supplemental oxygen and in nonhospitalized patients breathing room air. The durability of this benefit across time periods with different circulating severe acute respiratory syndrome coronavirus 2 variants of concern (VOC) is unknown. This comparative effectiveness study in patients hospitalized for COVID-19 and not receiving supplemental oxygen at admission compared those starting remdesivir treatment in the first 2 days of admission with those receiving no remdesivir during their hospitalization across different VOC periods.
Method: Using a large, multicenter US hospital database, in-hospital mortality rates were compared among patients hospitalized for COVID-19 but not requiring supplemental oxygen at admission between December 2020 and April 2022. Patients receiving remdesivir at hospital admission were matched 1:1 to those not receiving remdesivir during hospitalization, using propensity score matching. Cox proportional hazards models were used to assess 14- and 28-day in-hospital mortality rates or discharge to hospice.
Results: Among the 121 336 eligible patients, 58 188 remdesivir-treated patients were matched to 17 574 unique patients not receiving remdesivir. Overall, 5.4% of remdesivir-treated and 7.3% in the non-remdesivir group died within 14 days, and 8.0% and 9.8%, respectively, died within 28 days. Remdesivir treatment was associated with a statistically significant reduction in the in-hospital mortality rate compared with non-remdesivir treatment (14-day and 28-day adjusted hazard ratios [95% confidence interval], 0.75 [0.68-0.83] and 0.83 [0.76-0.90], respectively). This significant mortality benefit endured across the different VOC periods.
Conclusions: Remdesivir initiation in patients hospitalized for COVID-19 and not requiring supplemental oxygen at admission was associated with a significantly reduced in-hospital mortality rate. These findings highlight a potential survival benefit when clinicians initiated remdesivir on admission across the dominant variant eras of the evolving pandemic.
Keywords: COVID-19; comparative effectiveness research; hospitalization; mortality; remdesivir.
. 2024 Apr 16;11(6)
fae202.doi: 10.1093/ofid/ofae202. eCollection 2024 Jun. Remdesivir is Associated with Reduced Mortality in Patients Hospitalized for COVID-19 Not Requiring Supplemental Oxygen
Essy Mozaffari[SUP] 1 [/SUP], Aastha Chandak[SUP] 2 [/SUP], Chidinma Chima-Melton[SUP] 3 [/SUP], Andre C Kalil[SUP] 4 [/SUP], Heng Jiang[SUP] 5 [/SUP], EunYoung Lee[SUP] 1 [/SUP], Celine Der-Torossian[SUP] 1 [/SUP], Mark Thrun[SUP] 1 [/SUP], Mark Berry[SUP] 1 [/SUP], Richard Haubrich[SUP] 1 [/SUP], Robert L Gottlieb[SUP] 6 7 8 9 [/SUP]
Affiliations
- PMID: 38894848
- PMCID: PMC11182948
- DOI: 10.1093/ofid/ofae202
Background: Remdesivir has demonstrated benefit in some hospitalized patients with coronavirus disease 2019 (COVID-19) on supplemental oxygen and in nonhospitalized patients breathing room air. The durability of this benefit across time periods with different circulating severe acute respiratory syndrome coronavirus 2 variants of concern (VOC) is unknown. This comparative effectiveness study in patients hospitalized for COVID-19 and not receiving supplemental oxygen at admission compared those starting remdesivir treatment in the first 2 days of admission with those receiving no remdesivir during their hospitalization across different VOC periods.
Method: Using a large, multicenter US hospital database, in-hospital mortality rates were compared among patients hospitalized for COVID-19 but not requiring supplemental oxygen at admission between December 2020 and April 2022. Patients receiving remdesivir at hospital admission were matched 1:1 to those not receiving remdesivir during hospitalization, using propensity score matching. Cox proportional hazards models were used to assess 14- and 28-day in-hospital mortality rates or discharge to hospice.
Results: Among the 121 336 eligible patients, 58 188 remdesivir-treated patients were matched to 17 574 unique patients not receiving remdesivir. Overall, 5.4% of remdesivir-treated and 7.3% in the non-remdesivir group died within 14 days, and 8.0% and 9.8%, respectively, died within 28 days. Remdesivir treatment was associated with a statistically significant reduction in the in-hospital mortality rate compared with non-remdesivir treatment (14-day and 28-day adjusted hazard ratios [95% confidence interval], 0.75 [0.68-0.83] and 0.83 [0.76-0.90], respectively). This significant mortality benefit endured across the different VOC periods.
Conclusions: Remdesivir initiation in patients hospitalized for COVID-19 and not requiring supplemental oxygen at admission was associated with a significantly reduced in-hospital mortality rate. These findings highlight a potential survival benefit when clinicians initiated remdesivir on admission across the dominant variant eras of the evolving pandemic.
Keywords: COVID-19; comparative effectiveness research; hospitalization; mortality; remdesivir.