Clinical outcomes of COVID-19 patients treated with convalescent plasma or remdesivir alone and in combination at a community hospital in California's central valley

ABSTRACT

Rationale The optimal treatment regimen for hospitalized patients with COVID-19 infection remains to be determined. The purpose of this study was to compare how treatment with convalescent plasma (CP) monotherapy, remdesivir (RDV) monotherapy, and combination therapy (CP + RDV) in patients with COVID-19 affected clinical outcomes. Methods: This retrospective observational study was conducted between May-August 2020 at a 150-bed academic community hospital in San Joaquin County, California. Patients with COVID-19 infection who were hospitalized during the study period received CP, RDV, or a combination of both. Clinical outcomes including mortality, discharge disposition, hospital length of stay, ICU length of stay, and total ventilation days were compared between each treatment group and stratified by ABO blood group. An exploratory analysis identified risk factors for mortality. Adverse effects were also evaluated. Results: A total of 213 patients with COVID-19 were admitted and 106 patients received one of the three prespecified treatments during the study period. 53 received CP alone, 11 received RDV alone, and 42 received combination therapy. RDV monotherapy showed an increased chance of survival compared to combination therapy or CP monotherapy (p = 0.052) (Figure 1). There were 15, 3, and 6 deaths in the CP, RDV, and CP + RDV groups, respectively. The median number of ventilation days was the longest in the CP + RDV group (8, IQR 4.5-14, p = 0.091). The median ICU length of stay was also longest in the CP + RDV group (8, IQR 4.5-15.5, p = 0.220). The median hospital length of stay was longest in the CP group (11, IQR 7-15.5, p = 0.175). Age (p = 0.036), initial SOFA score (p = 0.013), and intubation (p = 0.005) were statistically significant predictors of mortality. Patients with type O blood had less ventilation days, ICU LOS, and total LOS but the difference was not statistically significant. Thirteen treatment-related adverse events occurred. Conclusion: No significant differences in clinical outcomes including mortality, length of stay, or total ventilator days were observed between hospitalized patients with COVID 19 treated with RDV, CP, or CP + RDV. Elderly patients, those with a high initial SOFA score, and those who require intubation are at increased risk of mortality associated with COVID-19. Blood type did not demonstrate significant differences in clinical outcomes.