Remdesivir reduced mortality in immunocompromised patients hospitalized for COVID-19 across variant waves: Findings from routine clinical practice.

Mozaffari et al., Clinical Infectious Diseases, doi:10.1093/cid/ciad460

Aug 2023

Retrospective 19,184 immunocompromised patients treated with remdesivir and matched controls, showing lower mortality with treatment. Several authors work at Gilead and the study was funded by Gilead.

The majority of patients were treated with remdesivir. A significant fraction of non-remdesivir patients may have contraindications that also increase risk. Authors provide serum creatine for 26% of the cohort, but notably provide only median and IQR, not allowing comparison of the number of patients with high values. Authors state that "renal function was not significantly different" between remdesivir and non-remdesivir patients, but this does not seem realistic given the prevalence of renal impairment and the contraindictions for remdesivir.

Gérard, Wu, Zhou show significantly increased risk of acute kidney injury with remdesivir.

1. Gérard et al., Remdesivir and Acute Renal Failure: A Potential Safety Signal From Disproportionality Analysis of the WHO Safety Database, Clinical Pharmacology & Therapeutics, doi:10.1002/cpt.2145.wiley.com, doi.org.

2. Wu et al., Acute Kidney Injury Associated With Remdesivir: A Comprehensive Pharmacovigilance Analysis of COVID-19 Reports in FAERS, Frontiers in Pharmacology, doi:10.3389/fphar.2022.692828.frontiersin.org, doi.org.

3. Zhou et al., Acute Kidney Injury and Drugs Prescribed for COVID-19 in Diabetes Patients: A Real-World Disproportionality Analysis, Frontiers in Pharmacology, doi:10.3389/fphar.2022.833679.frontiersin.org, doi.org.

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risk of death, 25.0% lower, HR 0.75, p < 0.001, treatment 14,169, control 5,341, adjusted per study, propensity score matching, Cox proportional hazards, day 28.

risk of death, 30.0% lower, HR 0.70, p < 0.001, treatment 14,169, control 5,341, adjusted per study, propensity score matching, Cox proportional hazards, day 14.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

Mozaffari et al., 9 Aug 2023, retrospective, USA, peer-reviewed, 11 authors, study period 1 December, 2020 - 30 April, 2022. Contact: akalil@unmc.edu, robert.gottlieb@bswhealth.org.

This Paper Remdesivir All

Remdesivir reduced mortality in immunocompromised patients hospitalized for COVID-19 across variant waves: Findings from routine clinical practice.

Essy Mozaffari, Aastha Chandak, Dr Robert L Gottlieb, Chidinma Chima-Melton, Stephanie H Read, Heng Jiang, Mel Chiang, Eunyoung Lee, Rikisha Gupta, Mark Berry, Dr Andre C Kalil

Clinical Infectious Diseases, doi:10.1093/cid/ciad460

Background: Immunocompromised patients are at high risk of severe COVID-19 and death, yet treatment strategies for immunocompromised patients hospitalized for COVID-19 reflect variations in clinical practice. This comparative effectiveness study investigated the effect of remdesivir treatment on inpatient mortality among immunocompromised patients hospitalized for COVID-19 across all variants of concern (VOC) periods.

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Late treatment
is less effective

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