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0 0.5 1 1.5 2+ Mortality, day 28 12% Improvement Relative Risk Mortality, day 14 24% Remdesivir  Mozaffari et al.  LATE TREATMENT Is late treatment with remdesivir beneficial for COVID-19? Retrospective 57,710 patients in the USA Lower mortality with remdesivir (p=0.0032) Mozaffari et al., Clinical Infectious .., Oct 2021 Favors remdesivir Favors control

Remdesivir treatment in hospitalized patients with COVID-19: a comparative analysis of in-hospital all-cause mortality in a large multi-center observational cohort

Mozaffari et al., Clinical Infectious Diseases, doi:10.1093/cid/ciab875
Oct 2021  
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Retrospective 28,855 remdesivir patients with PSM matched controls, showing lower mortality with treatment.
Gérard, Wu, Zhou show significantly increased risk of acute kidney injury with remdesivir.
risk of death, 12.0% lower, HR 0.88, p = 0.003, treatment 4,441 of 28,855 (15.4%), control 5,499 of 28,855 (19.1%), NNT 27, adjusted per study, PSM, Cox proportional hazards, day 28.
risk of death, 24.0% lower, HR 0.76, p < 0.001, treatment 3,057 of 28,855 (10.6%), control 4,437 of 28,855 (15.4%), NNT 21, adjusted per study, PSM, Cox proportional hazards, day 14.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Mozaffari et al., 1 Oct 2021, retrospective, USA, peer-reviewed, 12 authors.
This PaperRemdesivirAll
Essy Mozaffari, Aastha Chandak, Zhiji Zhang, Shuting Liang, Mark Thrun, MD Robert L Gottlieb, Daniel R Kuritzkes, Paul E Sax, David A Wohl, Roman Casciano, Paul Hodgkins, Richard Haubrich
Background: Remdesivir (RDV) improved clinical outcomes among hospitalized COVID-19 patients in randomized trials, but data from clinical practice are limited. Methods: We examined survival outcomes for US patients hospitalized with COVID-19 between Aug-Nov 2020 and treated with RDV within two-days of hospitalization vs. those not receiving RDV during their hospitalization using the Premier Healthcare Database. Preferential within-hospital propensity score matching with replacement was used. Additionally, patients were also matched on baseline oxygenation level (no supplemental oxygen charges (NSO), low-flow oxygen (LFO), high-flow oxygen/non-invasive ventilation (HFO/NIV) and invasive mechanical ventilation/ECMO (IMV/ECMO) and two-month admission window and excluded if discharged within 3-days of admission (to exclude anticipated discharges/transfers within 72-hrs consistent with ACTT-1 study). Cox Proportional Hazards models were used to assess time to 14-/28-day mortality overall and for patients on NSO, LFO, HFO/NIV and IMV/ECMO. Results: 28,855 RDV patients were matched to 16,687 unique non-RDV patients. Overall, 10.6% and 15.4% RDV patients died within 14-and 28-days, respectively compared with 15.4% and 19.1% non-RDV patients. Overall, RDV was associated with a reduction in mortality at 14-days (HR[95% CI]: 0.76*0.70−0.83+) and 28-days (0.89*0.82−0.96+). This mortality benefit was also seen for NSO, LFO and IMV/ECMO at 14-days (NSO:0.69*0.57−0.83+, LFO:0.68*0.80−0.77+, IMV/ECMO:0.70*0.58−0.84+) and 28-days (NSO:0.80*0.68−0.94+, LFO:0.77*0.68−0.86+, IMV/ECMO:0.81*0.69−0.94+). Additionally, HFO/NIV RDV group had a lower risk of mortality at 14-days (0.81*0.70−0.93+) but no statistical significance at 28-days.
Acosta, Mathis, Budnitz, Geller, Chai et al., COVID-19
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Late treatment
is less effective
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