Association of Remdesivir Treatment With Survival and Length of Hospital Stay Among US Veterans Hospitalized With COVID-19
Retrospective 5,898 hospitalized patients in the USA, 2,374 receiving remdesivir treatment, showing no significant difference in mortality, and a longer time to hospital discharge with treatment.[Gérard, Wu, Zhou]
show significantly increased risk of acute kidney injury with remdesivir.
risk of death, 6.0% higher, HR 1.06, p = 0.66, treatment 143 of 1,172 (12.2%), control 124 of 1,172 (10.6%), adjusted per study, PSM, Cox proportional hazards regression.
hospitalization time, 100% higher, relative time 2.00, p < 0.001, treatment 1,172, control 1,172, PSM, Cox proportional hazards regression.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Ohl et al., 15 Jul 2021, retrospective, propensity score matching, USA, peer-reviewed, 9 authors.
Abstract: Original Investigation | Infectious Diseases
Association of Remdesivir Treatment With Survival and Length of Hospital Stay
Among US Veterans Hospitalized With COVID-19
Michael E. Ohl, MD, MSPH; Donald R. Miller, ScD; Brian C. Lund, PharmD; Takaaki Kobayashi, MD; Kelly Richardson Miell, PhD; Brice F. Beck, MA; Bruce Alexander, PharmD;
Kristina Crothers, MD; Mary S. Vaughan Sarrazin, PhD
IMPORTANCE Randomized clinical trials have yielded conflicting results about the effects of
remdesivir therapy on survival and length of hospital stay among people with COVID-19.
Question Is remdesivir treatment
associated with improved survival or
shortened hospitalizations among
OBJECTIVE To examine associations between remdesivir treatment and survival and length of
hospital stay among people hospitalized with COVID-19 in routine care settings.
people with COVID-19 in routine care
Findings In this cohort study of 2344
DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the
US veterans hospitalized with COVID-19,
Veterans Health Administration (VHA) to identify adult patients in 123 VHA hospitals who had a first
remdesivir therapy was not associated
hospitalization with laboratory-confirmed COVID-19 from May 1 to October 8, 2020. Propensity
with improved 30-day survival but was
score matching of patients initiating remdesivir treatment to control patients who had not initiated
associated with a significant increase in
remdesivir treatment by the same hospital day was used to create the analytic cohort.
median time to hospital discharge.
Meaning The findings suggest that
EXPOSURES Remdesivir treatment.
routine use of remdesivir may be
associated with increased use of
MAIN OUTCOMES AND MEASURES Time to death within 30 days of remdesivir treatment
initiation (or corresponding hospital day for matched control individuals) and time to hospital
hospital beds but not with
improvements in survival.
discharge with time to death as a competing event. Associations between remdesivir treatment and
these outcomes were assessed using Cox proportional hazards regression in the matched cohort.
RESULTS The initial cohort included 5898 patients admitted to 123 hospitals, 2374 (40.3%) of
whom received remdesivir treatment (2238 men [94.3%]; mean [SD] age, 67.8 [12.8] years) and
3524 (59.7%) of whom never received remdesivir treatment (3302 men [93.7%]; mean [SD] age,
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67.0 [14.4] years). After propensity score matching, the analysis included 1172 remdesivir recipients
and 1172 controls, for a final matched cohort of 2344 individuals. Remdesivir recipients and matched
controls were similar with regard to age (mean [SD], 66.6 [14.2] years vs 67.5 [14.1] years), sex (1101
men [93.9%] vs 1101 men [93.9%]), dexamethasone use (559 [47.7%] vs 559 [47.7%]), admission to
the intensive care unit (242 [20.7%] vs 234 [19.1%]), and mechanical ventilation use (69 [5.9%] vs
45 [3.8%]). Standardized differences were less than 10% for all measures. Remdesivir treatment was
not associated with 30-day mortality (143 remdesivir recipients [12.2%] vs 124 controls [10.6%]; log
rank P = .26; adjusted hazard ratio [HR], 1.06; 95% CI, 0.83-1.36). Results were similar for people
receiving vs not receiving dexamethasone at remdesivir initiation (dexamethasone recipients:
adjusted HR, 0.93; 95%..
is less effective
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