The association of remdesivir and in-hospital outcomes for COVID-19 patients treated with steroids
Kuno et al.
, The association of remdesivir and in-hospital outcomes for COVID-19 patients treated with steroids
, Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkab256
PSM retrospective 3,372 hospitalized patients in the USA treated with steroids, showing no significant difference in mortality with remdesivir, but a lower risk of acute kidney injury.[Gérard, Wu, Zhou]
show significantly increased risk of acute kidney injury with remdesivir.
risk of death, 0.9% lower, RR 0.99, p = 0.96, treatment 214 of 999 (21.4%), control 216 of 999 (21.6%), NNT 499, PSM.
risk of mechanical ventilation, no change, RR 1.00, p = 1.00, treatment 140 of 999 (14.0%), control 140 of 999 (14.0%), PSM.
risk of ICU admission, 17.1% higher, RR 1.17, p = 0.05, treatment 260 of 999 (26.0%), control 222 of 999 (22.2%), PSM.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Kuno et al., 9 Aug 2021, retrospective, propensity score matching, USA, peer-reviewed, 6 authors.
Abstract: J Antimicrob Chemother
The association of remdesivir and in-hospital outcomes for COVID-19
patients treated with steroids
*, Yoshihisa Miyamoto2, Masao Iwagami3, Miho Ishimaru3, Mai Takahashi1 and
Natalia N. Egorova4
Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA; 2Division of Nephrology
and Endocrinology, The University of Tokyo, Tokyo, Japan; 3Department of Health Services Research, University of Tsukuba, Tsukuba,
Japan; 4Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
*Corresponding author. E-mail: Toshiki.Kuno@mountsinai.org; email@example.com
Received 11 May 2021; accepted 25 June 2021
Background: Remdesivir has been shown to decrease SARS-CoV-2 viral loads and the duration of COVID-19
symptoms. However, current evidence regarding the association between remdesivir and in-hospital mortality
for patients with COVID-19 steroid treatments is limited. We aimed to investigate whether remdesivir reduces
in-hospital mortality among patients with COVID-19 treated with steroids.
Methods: In this retrospective multicentre study, we reviewed the medical records of 3372 patients discharged
between 1 March 2020 and 30 March 2021, with laboratory confirmed COVID-19 in the Mount Sinai Health
System and treated with steroids. We evaluated the effect of remdesivir on the outcomes using propensity score
analyses. Subgroup analyses were conducted by stratification of patients by endotracheal intubation and
COVID-19 antibody status. Acute kidney injury (AKI) was defined as an absolute serum creatinine increase of
0.3 mg/dL or a relative increase of 50%.
Results: Of the 3372 eligible patients, 1336 (39.6%) received remdesivir. After 1:1 propensity score matching
(N = 999 pairs), in-hospital mortality was similar between those with and without remdesivir (21.4% versus
21.6%, respectively, P = 0.96). Remdesivir was not significantly associated with in-hospital mortality regardless
of endotracheal intubation or COVID-19 antibody status. However, there was a signal that remdesivir was associated with a reduced risk of AKI in the propensity matched analysis (17.5% versus 23.4%, respectively, P = 0.001).
Conclusions: Remdesivir was not associated with reduced risk of in-hospital mortality in patients with COVID-19
treated with steroids but potentially associated with decreased risk of AKI. These findings should be confirmed
in prospective studies focusing on COVID-19 patients treated with steroids.
is less effective
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