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0 0.5 1 1.5 2+ Mortality, day 60 35% Improvement Relative Risk Mortality, day 30 44% Remdesivir for COVID-19  Diaz et al.  LATE TREATMENT Is late treatment with remdesivir beneficial for COVID-19? Retrospective 1,138 patients in the USA Lower mortality with remdesivir (p=0.014) Diaz et al., Clinical Infectious Disea.., Aug 2021 Favors remdesivir Favors control

Remdesivir and Mortality in Patients with COVID-19

Diaz et al., Clinical Infectious Diseases, doi:10.1093/cid/ciab698
Aug 2021  
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Retrospective 1138 hospitalized patients in the USA, 286 treated with remdesivir, showing lower mortality with treatment.
Age was not included in the adjustments (authors excluded variables that contributed to another score, in this case age is in Pneumonia Severity Index).
Gérard, Wu, Zhou show significantly increased risk of acute kidney injury with remdesivir.
risk of death, 34.7% lower, HR 0.65, p = 0.01, treatment 33 of 286 (11.5%), control 173 of 852 (20.3%), NNT 11, adjusted per study, odds ratio converted to relative risk, multivariable, Cox proportional hazards, day 60.
risk of death, 44.0% lower, HR 0.56, p = 0.04, treatment 286, control 852, adjusted per study, multivariable, Cox proportional hazards, day 30, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Diaz et al., 19 Aug 2021, retrospective, USA, peer-reviewed, 45 authors.
This PaperRemdesivirAll
MD George A Diaz, PharmD, BCIDP Alyssa B Christensen, MD Tobias Pusch, MD Delaney Goulet, PhD Shu-Ching Chang, PhD Gary L Grunkemeier, MISM Paul A Mckelvey, MD Ari Robicsek, MS Tom French, MD Guilford T Parsons, MPH Glenn Doherty, MS Charles Laurenson, Ryan Roper, MD Jennifer Hadlock, MD, MPH Cameron J Cover, PharmD, BCPS Brent Footer, MD Philip Robinson, ARNP Mary Micikas, MD Jennifer E Marfori, Charlotte Cronenweth, Yogavedya Mukkamala, Jamie Mackiewicz, Ekra Rai, Martha Dickinson Matson, RN Jodie Davila, Justin Rueda, Reda Tipton, Heather Algren Rn, MD Brittney C Ward, MD Stephen Malkoski, MD Tyler Gluckman, PharmD Gregory B Tallman, MD Henry Arguinchona, MD Terese C Hammond, MD Steven Standaert, MD Joshua Christensen, MD, MPH Jose F Echaiz, MD, MPH Robert Choi, MD Daniel Mcclung, MD Albert Pacifico, MD Martin Fee, MD Farjad Sarafian, MD, PhD William R Berrington, MD, MPH Jason D Goldman
From an early retrospective cohort of hospitalized COVID-19 patients, remdesivir use is associated with lower mortality compared to best supportive care. The effect remains the same for the subgroup of patients requiring low flow oxygen at baseline, similar to the ACTT-1 results.
Disclaimer The manufacturer of RDV (Gilead Sciences, Inc.) and the sponsor of ACTT-1 (NIH NIAID) approved the reuse of data for this study, but was not involved in study design, data preparation, data analysis or manuscript preparation. A c c e p t e d M a n u s c r i p t
Beigel, Tomashek, Dodd, Remdesivir for the Treatment of Covid-19 -Final Report, N Engl J Med, doi:10.1056/NEJMoa2007764
Cavalcanti, Zampieri, Rosa, Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19, N Engl J Med, doi:10.1056/NEJMoa2019014
Fine, Auble, Yealy, A prediction rule to identify low-risk patients with community-acquired pneumonia, N Engl J Med. Jan, doi:10.1056/NEJM199701233360402
Geleris, Sun, Platt, Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19, N Engl J Med, doi:10.1056/NEJMoa2012410
Goldman, Lye, Hui, Remdesivir for 5 or 10 Days in Patients with Severe Covid-19, N Engl J Med, doi:10.1056/NEJMoa2015301
Gordon, Tchesnokov, Feng, Porter, Gotte, The antiviral compound remdesivir potently inhibits RNA-dependent RNA polymerase from Middle East respiratory syndrome coronavirus, J Biol Chem, doi:10.1074/jbc.AC120.013056
Grein, Ohmagari, Shin, Compassionate Use of Remdesivir for Patients with Severe Covid-19, New England Journal of Medicine, doi:10.1056/nejmoa2007016
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Rosenberg, Dufort, Udo, Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State, JAMA, doi:10.1001/jama.2020.8630
Skipper, Pastick, Engen, Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19 : A Randomized Trial, Ann Intern Med, doi:10.7326/M20-4207
Spinner, Gottlieb, Criner, Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19: A Randomized Clinical Trial, JAMA. Sep, doi:10.1001/jama.2020.16349
Tang, Cao, Han, Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial, BMJ, doi:10.1136/bmj.m1849
Yao, Ye, Zhang, Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), Clin Infect Dis, doi:10.1093/cid/ciaa237
Late treatment
is less effective
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