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0 0.5 1 1.5 2+ Mortality 1% Improvement Relative Risk Ventilation 0% ICU admission -17% Kuno et al. Remdesivir for COVID-19 LATE TREATMENT Is late treatment with remdesivir beneficial for COVID-19? PSM retrospective 1,998 patients in the USA Higher ICU admission with remdesivir (not stat. sig., p=0.053) Kuno et al., J. Antimicrobial Chemotherapy, doi:10.1093/jac/dkab256 Favors remdesivir Favors control
The association of remdesivir and in-hospital outcomes for COVID-19 patients treated with steroids
Kuno et al., Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkab256
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
Aug 2021   Source   PDF  
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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.
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This PaperRemdesivirAll
The association of remdesivir and in-hospital outcomes for COVID-19 patients treated with steroids
Toshiki Kuno, Yoshihisa Miyamoto, Masao Iwagami, Miho Ishimaru, Mai Takahashi, Natalia N Egorova
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.
COVID-19 and remdesivir Author contributions Data curation, full access to all of the data in the study and responsibility taken for the integrity of the data and the accuracy of the data analysis: T.K., M.T. and N.N.E. Study concept and design, and drafting of the manuscript: T.K. Statistical analysis: T.K. and M.T. Administrative, technical, or material support, and study supervision: N.N.E. Acquisition, analysis, or interpretation of data, and critical revision of the manuscript for important intellectual content: all authors.
Acosta-Ochoa, Bustamante-Munguira, Mendiluce-Herrero, Impact on outcomes across KDIGO-2012 AKI criteria according to baseline renal function, J Clin Med
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Beigel, Tomashek, Dodd, Remdesivir for the treatment of COVID-19 -final report, N Engl J Med
Chandiramani, Cao, Contrast-induced acute kidney injury, Cardiovasc Interv Ther
Eikelboom, Connolly, Bosch, Rivaroxaban with or without aspirin in stable cardiovascular disease, N Engl J Med
Gabarre, Dumas, Dupont, Acute kidney injury in critically ill patients with COVID-19, Intensive Care Med
Kaka, Macdonald, Greer, Major update: remdesivir for adults with COVID-19: a living systematic review and meta-analysis for the American College of Physicians practice points, Ann Intern Med
Kuno, Takahashi, Egorova, The association between convalescent plasma treatment and survival of patients with COVID-19, J Gen Intern Med, doi:10.1007/s11606-021-06894-3
Lai, Chen, Wang, Clinical efficacy and safety of remdesivir in patients with COVID-19: a systematic review and network meta-analysis of randomized controlled trials, J Antimicrob Chemother, doi:10.1093/jac/dkab093
Levey, Stevens, Schmid, A new equation to estimate glomerular filtration rate, Ann Intern Med
Maeda, Obata, Rizk, Cardiac injury and outcomes of patients with COVID-19 in New York City, Heart Lung Circ
Maeda, Obata, Rizk, The association of interleukin-6 value, interleukin inhibitors, and outcomes of patients with COVID-19 in New York City, J Med Virol
Mehta, Bansal, Bysani, A shorter symptom-onset to remdesivir treatment (SORT) interval is associated with a lower mortality in moderate-to-severe COVID-19: a real-world analysis, Int J Infect Dis
Mehta, Mcauley, Brown, Repurposed Antiviral Drugs for COVID-19 -Interim WHO Solidarity Trial Results, N Engl J Med
Nadim, Forni, Mehta, COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup, Nat Rev Nephrol
Obata, Maeda, Rizk, Palliative care team involvement in patients with COVID-19 in New York City, Am J Hosp Palliat Care
Petrilli, Jones, Yang, Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study, BMJ
Recovery Collaborative Group, Horby, Lim, Emberson, Dexamethasone in hospitalized patients with COVID-19 -Preliminary Report, N Engl J Med
Rezagholizadeh, Khiali, Sarbakhsh, Remdesivir for treatment of COVID-19; an updated systematic review and meta-analysis, Eur J Pharmacol
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So, Steiger, Takahashi, The characteristics and outcomes of critically Ill patients with COVID-19 who received systemic thrombolysis for presumed pulmonary embolism: an observational study, J Thromb Thrombolysis, doi:10.1007/s11239-021-02477-5
Sterne, Murthy, Diaz, Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: a meta-analysis, JAMA
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Late treatment
is less effective
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