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

DOI record: { "DOI": "10.1101/2020.11.19.20234153", "URL": "http://dx.doi.org/10.1101/2020.11.19.20234153", "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>", "accepted": { "date-parts": [ [ 2020, 11, 20 ] ] }, "author": [ { "ORCID": "http://orcid.org/0000-0001-8632-5567", "affiliation": [], "authenticated-orcid": false, "family": "Garibaldi", "given": "Brian T.", "sequence": "first" }, { "affiliation": [], "family": "Wang", "given": "Kunbo", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0003-0376-8560", "affiliation": [], "authenticated-orcid": false, "family": "Robinson", "given": "Matthew L.", "sequence": "additional" }, { "affiliation": [], "family": "Zeger", "given": "Scott L.", "sequence": "additional" }, { "affiliation": [], "family": "Roche", "given": "Karen Bandeen", "sequence": "additional" }, { "affiliation": [], "family": "Wang", "given": "Mei-Cheng", "sequence": "additional" }, { "affiliation": [], "family": "Alexander", "given": "G. Caleb", "sequence": "additional" }, { "affiliation": [], "family": "Gupta", "given": "Amita", "sequence": "additional" }, { "affiliation": [], "family": "Bollinger", "given": "Robert", "sequence": "additional" }, { "affiliation": [], "family": "Xu", "given": "Yanxun", "sequence": "additional" } ], "container-title": [], "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2020, 11, 20 ] ], "date-time": "2020-11-20T20:46:24Z", "timestamp": 1605905184000 }, "deposited": { "date-parts": [ [ 2020, 11, 22 ] ], "date-time": "2020-11-22T19:26:02Z", "timestamp": 1606073162000 }, "group-title": "Infectious Diseases (except HIV/AIDS)", "indexed": { "date-parts": [ [ 2023, 11, 30 ] ], "date-time": "2023-11-30T16:21:00Z", "timestamp": 1701361260713 }, "institution": [ { "name": "medRxiv" } ], "is-referenced-by-count": 6, "issued": { "date-parts": [ [ 2020, 11, 20 ] ] }, "link": [ { "URL": "https://syndication.highwire.org/content/doi/10.1101/2020.11.19.20234153", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "246", "original-title": [], "posted": { "date-parts": [ [ 2020, 11, 20 ] ] }, "prefix": "10.1101", "published": { "date-parts": [ [ 2020, 11, 20 ] ] }, "publisher": "Cold Spring Harbor Laboratory", "reference": [ { "key": "2020112211250549000_2020.11.19.20234153v1.1", "unstructured": "COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). 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