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Remdesivir Plus Dexamethasone Versus Dexamethasone Alone for the Treatment of Coronavirus Disease 2019 (COVID-19) Patients Requiring Supplemental O2 Therapy: A Prospective Controlled Nonrandomized Study.
Marrone, Aldo; Nevola, Riccardo; Sellitto, Ausilia; Cozzolino, Domenico; Romano, Ciro; Cuomo, Giovanna; Aprea, Concetta; Schwartzbaum, Michelangelo X Palou; Ricozzi, Carmen; Imbriani, Simona; Rinaldi, Luca; Gjeloshi, Klodian; Padula, Andrea; Ranieri, Roberta; Ruosi, Carolina; Meo, Luciana Agnese; Abitabile, Marianna; Cinone, Francesca; Carusone, Caterina; Adinolfi, Luigi Elio.
  • Marrone A; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
  • Nevola R; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
  • Sellitto A; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
  • Cozzolino D; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
  • Romano C; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
  • Cuomo G; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
  • Aprea C; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
  • Schwartzbaum MXP; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
  • Ricozzi C; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
  • Imbriani S; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
  • Rinaldi L; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
  • Gjeloshi K; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
  • Padula A; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
  • Ranieri R; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
  • Ruosi C; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
  • Meo LA; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
  • Abitabile M; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
  • Cinone F; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
  • Carusone C; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
  • Adinolfi LE; Internal Medicine COVID CENTER; Department of Advanced Medical and Surgery Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
Clin Infect Dis ; 75(1): e403-e409, 2022 08 24.
Article in English | MEDLINE | ID: covidwho-1746922
ABSTRACT

BACKGROUND:

Remdesivir is an antiviral used to treat coronavirus disease 2019 (COVID-19), which improves some clinical outcomes. Dexamethasone has been shown to be effective in reducing mortality. It has been hypothesized that combination of these two drugs can improve mortality. We evaluated the effect of combination on mortality of COVID-19 patients requiring O2 therapy.

METHODS:

A prospective quasi-experimental study, including two independent, sequential controlled cohorts, one received remdesivir-dexamethasone and the other dexamethasone alone, was designed. All COVID-19 patients requiring supplemental O2 therapy were enrolled consecutively. The sample size to power mortality was a priori calculated. The primary endpoints were 30-day mortality and viral clearance differences. Secondary endpoints were differences in hospitalization times, improvement in respiratory failure (PO2/FiO2) and inflammatory indices (fibrinogen, CRP, neutrophil/lymphocyte ratio, D-Dimer). Kaplan-Meier curves and the log-rank test were used to evaluate significant differences in mortality between groups.

RESULTS:

In total, 151 COVID-19 patients were enrolled (remdesivir/dexamethasone group, 76, and dexamethasone alone, 75). No differences in demographic, clinical, and laboratory characteristics were observed between the 2 groups at baseline. Faster viral clearance occurred in the remdesivir/dexamethasone group compared to dexamethasone alone (median 6 vs 16 days; P < .001). The 30-day mortality in the remdesivir/dexamethasone group was 1.3%, whereas in dexamethasone alone was 16% (P < .005). In the remdesivir/dexamethasone group compared to dexamethasone alone there was a reduction in hospitalization days (P < .0001) and a faster improvement in both respiratory function and inflammatory markers.

CONCLUSIONS:

Remdesivir/dexamethasone treatment is associated with significant reduction in mortality, length of hospitalization, and faster SARS-CoV-2 clearance, compared to dexamethasone alone.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Clin Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: Cid

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Clin Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: Cid