Effectiveness of remdesivir with and without dexamethasone in hospitalized patients with COVID-19

{ 'institution': [{'name': 'medRxiv'}], 'indexed': { 'date-parts': [[2023, 11, 30]], 'date-time': '2023-11-30T16:21:00Z', 'timestamp': 1701361260713}, 'posted': {'date-parts': [[2020, 11, 20]]}, 'group-title': 'Infectious Diseases (except HIV/AIDS)', 'reference-count': 25, 'publisher': 'Cold Spring Harbor Laboratory', 'content-domain': {'domain': [], 'crossmark-restriction': False}, 'accepted': {'date-parts': [[2020, 11, 20]]}, 'abstract': '<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>Rationale</jats:title><jats:p>Remdesivir ' 'and dexamethasone reduced the severity of COVID-19 in clinical trials. However, their ' 'individual or combined effectiveness in clinical practice remains ' 'unknown.</jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p>To examine ' 'the effectiveness of remdesivir with or without ' 'dexamethasone.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Measurements and Main ' 'Results</jats:title><jats:p>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]).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Remdesivir ' 'offered a significantly faster time to clinical improvement among a cohort of predominantly ' 'non-white patients hospitalized with COVID-19, particularly with mild-moderate disease. ' 'Remdesivir plus dexamethasone may reduce mortality.</jats:p></jats:sec>', 'DOI': '10.1101/2020.11.19.20234153', 'type': 'posted-content', 'created': { 'date-parts': [[2020, 11, 20]], 'date-time': '2020-11-20T20:46:24Z', 'timestamp': 1605905184000}, 'source': 'Crossref', 'is-referenced-by-count': 6, 'title': 'Effectiveness of remdesivir with and without dexamethasone in hospitalized patients with ' 'COVID-19', 'prefix': '10.1101', 'author': [ { 'ORCID': 'http://orcid.org/0000-0001-8632-5567', 'authenticated-orcid': False, 'given': 'Brian T.', 'family': 'Garibaldi', 'sequence': 'first', 'affiliation': []}, {'given': 'Kunbo', 'family': 'Wang', 'sequence': 'additional', 'affiliation': []}, { 'ORCID': 'http://orcid.org/0000-0003-0376-8560', 'authenticated-orcid': False, 'given': 'Matthew L.', 'family': 'Robinson', 'sequence': 'additional', 'affiliation': []}, {'given': 'Scott L.', 'family': 'Zeger', 'sequence': 'additional', 'affiliation': []}, {'given': 'Karen Bandeen', 'family': 'Roche', 'sequence': 'additional', 'affiliation': []}, {'given': 'Mei-Cheng', 'family': 'Wang', 'sequence': 'additional', 'affiliation': []}, {'given': 'G. 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