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0 0.5 1 1.5 2+ Mortality 61% Improvement Relative Risk Ventilation -37% Fried et al. Remdesivir for COVID-19 LATE TREATMENT Is late treatment with remdesivir beneficial for COVID-19? Retrospective 11,721 patients in the USA Lower mortality with remdesivir (p=0.022) Fried et al., Clinical Infectious Disease, doi:10.1093/cid/ciaa1268 Favors remdesivir Favors control
Patient Characteristics and Outcomes of 11,721 Patients with COVID19 Hospitalized Across the United States
Fried et al., Clinical Infectious Disease, doi:10.1093/cid/ciaa1268
Fried et al., Patient Characteristics and Outcomes of 11,721 Patients with COVID19 Hospitalized Across the United States, Clinical Infectious Disease, doi:10.1093/cid/ciaa1268
Aug 2020   Source   PDF  
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Database analysis of 11,721 hospitalized patients, 48 treated with remdesivir.
Data inconsistencies have been found in this study, for example 99.4% of patients treated with HCQ were treated in urban hospitals, compared to 65% of untreated patients (Supplemental Table 3), while patients are distributed in a more balanced manner between teaching or not-teaching hospitals, as well as in the most urbanized (Northeast) and less urbanized (Midwest) regions of the United States [].
[Gérard, Zhou] show significantly increased risk of acute kidney injury with remdesivir. This study is excluded in the after exclusion results of meta analysis: excessive unadjusted differences between groups; substantial unadjusted confounding by indication likely.
risk of death, 61.2% lower, RR 0.39, p = 0.02, treatment 4 of 48 (8.3%), control 2,510 of 11,673 (21.5%), NNT 7.6, remdesivir vs. non-remdesivir.
risk of mechanical ventilation, 36.8% higher, RR 1.37, p = 0.25, treatment 11 of 48 (22.9%), control 1,956 of 11,673 (16.8%), remdesivir vs. non-remdesivir.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Fried et al., 28 Aug 2020, retrospective, database analysis, USA, peer-reviewed, 11 authors.
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This PaperRemdesivirAll
Abstract: Clinical Infectious Diseases Major Article Patient Characteristics and Outcomes of 11 721 Patients With Coronavirus Disease 2019 (COVID-19) Hospitalized Across the United States Michael W. Fried,1 Julie M. Crawford,1 Andrea R. Mospan,1 Stephanie E. Watkins,1 Breda Munoz,1 Richard C. Zink,1 Sherry Elliott,2 Kyle Burleson,1 Charles Landis,3 K. Rajender Reddy,4 and Robert S. Brown Jr5 Background. As coronavirus disease 2019 (COVID-19) disseminates throughout the United States, a better understanding of the patient characteristics associated with hospitalization, morbidity, and mortality in diverse geographic regions is essential. Methods. Hospital chargemaster data on adult patients with COVID-19 admitted to 245 hospitals across 38 states between 15 February and 20 April 2020 were assessed. The clinical course from admission, through hospitalization, and to discharge or death was analyzed. Results. A total of 11 721 patients were included (majority were >60 years of age [59.9%] and male [53.4%]). Comorbidities included hypertension (46.7%), diabetes (27.8%), cardiovascular disease (18.6%), obesity (16.1%), and chronic kidney disease (12.2%). Mechanical ventilation was required by 1967 patients (16.8%). Mortality among hospitalized patients was 21.4% and increased to 70.5% among those on mechanical ventilation. Male sex, older age, obesity, geographic region, and the presence of chronic kidney disease or a preexisting cardiovascular disease were associated with increased odds of mechanical ventilation. All aforementioned risk factors, with the exception of obesity, were associated with increased odds of death (all P values < .001). Many patients received investigational medications for treatment of COVID-19, including 48 patients on remdesivir and 4232 on hydroxychloroquine. Conclusions. This large observational cohort describes the clinical course and identifies factors associated with the outcomes of hospitalized patients with COVID-19 across the United States. These data can inform strategies to prioritize prevention and treatment for this disease. Keywords. SARS-CoV-2; COVID-19; observational study; hydroxychloroquine; remdesivir. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1] is a novel coronavirus identified initially in Wuhan, China, in 2019. The virus causes coronavirus disease 2019 (COVID-19) [2], which subsequently has created outbreaks across the world, resulting in over 5.2 million cases and over 327 000 deaths globally [3]. In the United States, the first case of COVID-19 was reported on 20 January 2020 in Washington state [4]. As of 5 August 2020, there have been over 4.6 million confirmed cases and 154 952 deaths attributed to COVID-19 in the United States [3]. In early reports in China and the United States, increasing age and comorbid diseases, most notably cardiovascular disease, diabetes, hypertension, and chronic kidney disease, were associated with increased disease severity and death [5–7]. According to the Centers for Disease Control and Prevention Received 5 June 2020; editorial decision 19 August 2020; accepted 24 August 2020; published online August 28, 2020. Correspondence: M. W. Fried, TARGET PharmaSolutions, Inc., 2520 Meridian Pkwy, Suite 105, Durham, NC 27713 ( Clinical Infectious Diseases®  2021;72(10):e558–65 © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions,..
Late treatment
is less effective
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