Remdesivir plus dexamethasone is associated to improve the clinical outcome of COVID-19 hospitalized patients regardless of their vaccination status Remdesivir más dexametasona se asocian a una reducción de los eventos clínicos en los pacientes hospitalizados por COVID-19, independientemente de su estado de vacunación

ABSTRACT

Introduction Remdesivir seems to reduce the risk of hospitalization and improve clinical outcome in hospitalized patients with COVID-19. Objectives To compare the clinical outcome of COVID-19 hospitalized patients treated with remdesivir plus dexamethasone versus dexamethasone alone, according to their vaccination status. Material and methods A retrospective observational study was carried out in 165 patients hospitalized for COVID-19 from October 2021 to January 2022. Multivariate logistic regression, Kaplan–Meier and the log-rank tests were used to evaluate the event (need for ventilation or death). Results Patients treated with remdesivir plus dexamethasone (n = 87) compared with dexamethasone alone (n = 78) showed similar age (60 ± 16, 47–70 vs. 62 ± 37, 51–74 years) and number of comorbidities 1 (0–2) versus 1.5 (1–3). Among 73 fully vaccinated patients, 42 (47.1%) were in remdesivir plus dexamethasone and 31 (41%) in dexamethasone alone. Patients treated with remdesivir plus dexamethasone needed intensive care less frequently (17.2% vs. 31%;p = 0.002), high-flow oxygen (25.3% vs. 50.0%;p = 0.002) and non-invasive mechanical ventilation (16.1% vs. 47.4%;p < 0.001). Furthermore, they had less complications during hospitalization (31.0% vs. 52.6%;p = 0.008), need of antibiotics (32.2% vs. 59%;p = 0.001) and radiologic worsening (21.8% vs. 44.9%;p = 0.005). Treatment with remdesivir plus dexamethasone (aHR, 0.26;95% CI 0.14–0.48;p < 0.001) and vaccination (aHR 0.39;95% CI 0.21–0.74) were independent factors associated with lower progression to mechanical ventilation or death. Conclusions Remdesivir in combination with dexamethasone and vaccination independently and synergistically protects hospitalized COVID-19 patients requiring oxygen therapy from progression to severe disease or dead.