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
doi:10.1093/cid/ciab875/6378778
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.
References
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'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>',
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