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Remdesivir treatment in hospitalized patients with COVID-19: a comparative analysis of in-hospital all-cause mortality in a large multi-center observational cohort.
Mozaffari, Essy; Chandak, Aastha; Zhang, Zhiji; Liang, Shuting; Thrun, Mark; Gottlieb, Robert L; Kuritzkes, Daniel R; Sax, Paul E; Wohl, David A; Casciano, Roman; Hodgkins, Paul; Haubrich, Richard.
  • Mozaffari E; Gilead Sciences, 333 Lakeside Drive, Foster City, CA, USA.
  • Chandak A; Certara, 295 Madison Ave, 23rd Fl, New York, NY, USA.
  • Zhang Z; Certara, 295 Madison Ave, 23rd Fl, New York, NY, USA.
  • Liang S; Gilead Sciences, 333 Lakeside Drive, Foster City, CA, USA.
  • Thrun M; Gilead Sciences, 333 Lakeside Drive, Foster City, CA, USA.
  • Gottlieb RL; Baylor University Medical Center Dallas; Baylor Scott and White Heart and Vascular Hospital; Baylor Scott and White The Heart Hospital Plano, and Baylor Scott and White Research Institute, 3410 Worth St, Suite 250, Dallas TX, USA.
  • Kuritzkes DR; Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne St, Cambridge, MA, USA.
  • Sax PE; Division of Infectious Diseases, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA.
  • Wohl DA; University of North Carolina, 130 Mason Farm Road, Chapel Hill, NC, USA.
  • Casciano R; Certara, 295 Madison Ave, 23rd Fl, New York, NY, USA.
  • Hodgkins P; Gilead Sciences, 333 Lakeside Drive, Foster City, CA, USA.
  • Haubrich R; Gilead Sciences, 333 Lakeside Drive, Foster City, CA, USA.
Clin Infect Dis ; 2021 Oct 01.
Article in English | MEDLINE | ID: covidwho-2017765
ABSTRACT

BACKGROUND:

Remdesivir (RDV) improved clinical outcomes among hospitalized COVID-19 patients in randomized trials, but data from clinical practice are limited.

METHODS:

We examined survival outcomes for US patients hospitalized with COVID-19 between Aug-Nov 2020 and treated with RDV within two-days of hospitalization vs. those not receiving RDV during their hospitalization using the Premier Healthcare Database. Preferential within-hospital propensity score matching with replacement was used. Additionally, patients were also matched on baseline oxygenation level (no supplemental oxygen charges (NSO), low-flow oxygen (LFO), high-flow oxygen/non-invasive ventilation (HFO/NIV) and invasive mechanical ventilation/ECMO (IMV/ECMO) and two-month admission window and excluded if discharged within 3-days of admission (to exclude anticipated discharges/transfers within 72-hrs consistent with ACTT-1 study). Cox Proportional Hazards models were used to assess time to 14-/28-day mortality overall and for patients on NSO, LFO, HFO/NIV and IMV/ECMO.

RESULTS:

28,855 RDV patients were matched to 16,687 unique non-RDV patients. Overall, 10.6% and 15.4% RDV patients died within 14- and 28-days, respectively compared with 15.4% and 19.1% non-RDV patients. Overall, RDV was associated with a reduction in mortality at 14-days (HR[95% CI] 0.76[0.70-0.83]) and 28-days (0.89[0.82-0.96]). This mortality benefit was also seen for NSO, LFO and IMV/ECMO at 14-days (NSO0.69[0.57-0.83], LFO0.68[0.80-0.77], IMV/ECMO0.70[0.58-0.84]) and 28-days (NSO0.80[0.68-0.94], LFO0.77[0.68-0.86], IMV/ECMO0.81[0.69-0.94]). Additionally, HFO/NIV RDV group had a lower risk of mortality at 14-days (0.81[0.70-0.93]) but no statistical significance at 28-days.

CONCLUSIONS:

RDV initiated upon hospital admission was associated with improved survival among COVID-19 patients. Our findings complement ACTT-1 and support RDV as a foundational treatment for hospitalized COVID-19 patients.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal subject: Communicable Diseases Year: 2021 Document Type: Article Affiliation country: Cid

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal subject: Communicable Diseases Year: 2021 Document Type: Article Affiliation country: Cid