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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DOI record:
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"abstract": "<jats:title>Abstract</jats:title>\n <jats:sec>\n <jats:title>Background</jats:title>\n <jats:p>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.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Methods</jats:title>\n <jats:p>Data for immunocompromised patients hospitalized for COVID-19 between December 2020 and April 2022 were extracted from the US PINC AI Healthcare Database. Patients initiating remdesivir within two days of hospitalization were matched 1:1 using propensity score matching with replacement to patients who did not receive remdesivir during their hospitalization for COVID-19. Additional matching criteria included admission month, age group, and hospital. Cox Proportional Hazards models were used to examine the effect of remdesivir on risk of 14- and 28-day mortality during VOC periods.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Results</jats:title>\n <jats:p>A total of 19,184 remdesivir patients were matched to 11,213 non-remdesivir patients. Overall, 11.1% and 17.7% of remdesivir patients died within 14 and 28 days, respectively, compared with 15.4% and 22.4% of non-remdesivir patients. Remdesivir was associated with a reduction in mortality at 14 days (hazard ratio [95% confidence interval]: 0.70 [0.62–0.78]) and 28 days (0.75 [0.68–0.83]). Survival benefit remained significant during the Pre-Delta, Delta, and Omicron time-periods.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Conclusions</jats:title>\n <jats:p>Prompt initiation of remdesivir in immunocompromised patients hospitalized for COVID-19 is associated with significant survival benefit across all variant waves. These findings provide much-needed evidence relating to the effectiveness of a foundational treatment for hospitalized COVID-19 patients among a high-risk population.</jats:p>\n </jats:sec>",
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