Real-World Safety and Effectiveness of Remdesivir and Corticosteroids in Hospitalized Patients with COVID-19

Real-world effectiveness studies of remdesivir in hospitalized patients with COVID-19 conducted to date have produced conflicting findings which may be due, in part, to treatment heterogeneity within standard of care comparison groups. Our objective was to evaluate the comparative effectiveness and safety of remdesivir in a cohort of patients all treated with corticosteroids. We conducted a retrospective cohort study in the National Veterans Affairs Healthcare System. We included hospitalized patients (>18 years old) with positive COVID-19 PCR tests and COVID-19 diagnosis codes, and corticosteroid treatment within 2 days of admission, from 1 May 2020 to 30 November 2021. Time-to-event outcomes included time to inpatient mortality (primary), discharge, mortality after discharge, readmission, and acute kidney injury and bacterial infection after treatment initiation. Propensity score (PS)-adjusted, PS-matched, and inverse probability of treatment weighted (IPTW) Cox proportional hazards regression models controlled for study timeframe, supplemental oxygen, vaccination status, and other important confounders. We observed significantly lower inpatient mortality, 90-day post-discharge mortality, 30-day post-discharge readmission, and significantly longer hospital stays in the remdesivir group (n = 14,509) compared with the non-remdesivir group (n = 4365). Higher rates of bacterial infections were observed in the remdesivir group. Acute kidney injury was lower in subgroup analyses restricting the study population to index dates in 2021, on supplemental oxygen, and fully vaccinated, and higher in those without baseline supplemental oxygen. When comparing the effectiveness and safety of remdesivir plus corticosteroids to a homogenous comparison group, all also treated with corticosteroids, mortality and readmission were significantly lower in the remdesivir group. Longer length of stay corresponds with duration of remdesivir treatment and may impact the risk of developing infections during the hospitalization, which requires further study.

Antimicrobial Prescribing in the Telehealth Setting: Framework for stewardship during a period of rapid acceleration within primary care.

Antibiotic resistance is a global public health threat. The use of telehealth in primary care presents unique barriers to antimicrobial stewardship, including limited physical examination and changes to the patient-provider relationship. Since the COVID-19 pandemic, there is a need to identify novel antimicrobial stewardship strategies with an explosion in the use of telehealth within primary care. Our review proposes a tailored, sustainable approach to antimicrobial prescribing in the telehealth setting based on the CDC's Core Elements of Outpatient Antibiotic Stewardship: commitment, action for policy and practice; tracking and reporting; and education and expertise. The rapid growth of telehealth for all types of primary care visits (not just antibiotic use) is outpacing knowledge associated with strategies for antimicrobial stewardship. Improving antibiotic use within primary care settings is critical as telehealth will remain a priority whether the COVID-19 pandemic recedes, particularly within patient populations with limited access to healthcare.