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

DOI record: { "DOI": "10.1093/cid/ciab875", "ISSN": [ "1058-4838", "1537-6591" ], "URL": "http://dx.doi.org/10.1093/cid/ciab875", "abstract": "<jats:title>Abstract</jats:title>\n <jats:sec>\n <jats:title>Background</jats:title>\n <jats:p>Remdesivir (RDV) improved clinical outcomes among hospitalized patients with coronavirus disease 2019 (COVID-19) in randomized trials, but data from clinical practice are limited.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Methods</jats:title>\n <jats:p>We examined survival outcomes for US patients hospitalized with COVID-19 between August and November 2020 and treated with RDV within 2 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/noninvasive ventilation [HFO/NIV], and invasive mechanical ventilation/extracorporeal membrane oxygenation [IMV/ECMO]) and 2-month admission window and excluded if discharged within 3 days of admission (to exclude anticipated discharges/transfers within 72 hours, consistent with the Adaptive COVID-19 Treatment Trial [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.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Results</jats:title>\n <jats:p>A total of 28855 RDV patients were matched to 16687 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 (hazard ratio [95% confidence interval]: 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.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Conclusions</jats:title>\n <jats:p>RDV initiated upon hospital admission was associated with improved survival among patients with COVID-19. Our findings complement ACTT-1 and support RDV as a foundational treatment for hospitalized COVID-19 patients.</jats:p>\n </jats:sec>", "author": [ { "affiliation": [ { "name": "Gilead Sciences , Foster City, California , USA" } ], "family": "Mozaffari", "given": "Essy", "sequence": "first" }, { "ORCID": "http://orcid.org/0000-0001-5653-435X", "affiliation": [ { "name": "Certara , New York, New York , USA" } ], "authenticated-orcid": false, "family": "Chandak", "given": "Aastha", "sequence": "additional" }, { "affiliation": [ { "name": "Certara , New York, New York , USA" } ], "family": "Zhang", "given": "Zhiji", "sequence": "additional" }, { "affiliation": [ { "name": "Gilead Sciences , Foster City, California , USA" } ], "family": "Liang", "given": "Shuting", "sequence": "additional" }, { "affiliation": [ { "name": "Gilead Sciences , Foster City, California , USA" } ], "family": "Thrun", "given": "Mark", "sequence": "additional" }, { "affiliation": [ { "name": "Baylor University Medical Center , Dallas, Texas , USA" }, { "name": "Baylor Scott and White Heart and Vascular Hospital , Dallas, Texas , USA" }, { "name": "Baylor Scott and White The Heart Hospital , Plano, Texas , USA" }, { "name": "Baylor Scott and White Research Institute , Dallas, Texas , USA" } ], "family": "Gottlieb", "given": "Robert L", "sequence": "additional" }, { "affiliation": [ { "name": "Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School , Cambridge, Massachusetts , USA" } ], "family": "Kuritzkes", "given": "Daniel R", "sequence": "additional" }, { "affiliation": [ { "name": "Division of Infectious Diseases, Brigham and Women’s Hospital , Boston, Massachusetts , USA" } ], "family": "Sax", "given": "Paul E", "sequence": "additional" }, { "affiliation": [ { "name": "University of North Carolina , Chapel Hill, North Carolina , USA" } ], "family": "Wohl", "given": "David A", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-7083-9536", "affiliation": [ { "name": "Certara , New York, New York , USA" } ], "authenticated-orcid": false, "family": "Casciano", "given": "Roman", "sequence": "additional" }, { "affiliation": [ { "name": "Gilead Sciences , Foster City, California , USA" } ], "family": "Hodgkins", "given": "Paul", "sequence": "additional" }, { "affiliation": [ { "name": "Gilead Sciences , Foster City, California , USA" } ], "family": "Haubrich", "given": "Richard", "sequence": "additional" } ], "container-title": "Clinical Infectious Diseases", "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2021, 9, 30 ] ], "date-time": "2021-09-30T15:31:22Z", "timestamp": 1633015882000 }, "deposited": { "date-parts": [ [ 2022, 8, 25 ] ], "date-time": "2022-08-25T03:09:44Z", "timestamp": 1661396984000 }, "funder": [ { "DOI": "10.13039/100005564", "doi-asserted-by": "publisher", "name": "Gilead Sciences" } ], "indexed": { "date-parts": [ [ 2024, 3, 26 ] ], "date-time": "2024-03-26T23:18:07Z", "timestamp": 1711495087917 }, "is-referenced-by-count": 76, "issue": "1", "issued": { "date-parts": [ [ 2021, 10, 1 ] ] }, "journal-issue": { "issue": "1", "published-online": { "date-parts": [ [ 2021, 10, 1 ] ] }, "published-print": { "date-parts": [ [ 2022, 8, 24 ] ] } }, "language": "en", "license": [ { "URL": "https://creativecommons.org/licenses/by-nc-nd/4.0/", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2021, 10, 1 ] ], "date-time": "2021-10-01T00:00:00Z", "timestamp": 1633046400000 } } ], "link": [ { "URL": "http://academic.oup.com/cid/advance-article-pdf/doi/10.1093/cid/ciab875/40509854/ciab875.pdf", "content-type": "application/pdf", "content-version": "am", "intended-application": "syndication" }, { "URL": "https://academic.oup.com/cid/article-pdf/75/1/e450/45514485/ciab875.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "syndication" }, { "URL": 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