Infectious Disease

Remdesivir use associated with increased survival among patients with COVID-19

Evan Vega October 28, 2023

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October 27, 2023

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Key takeaways:

Remdesivir treatment is associated with reduced mortality among hospitalized patients requiring supplemental oxygen.
This association was most distinct during the omicron wave.

Remdesivir use is associated with increased survival among patients hospitalized with COVID-19 requiring supplemental oxygen, researchers found.

“For every therapy with demonstrated evidence-based efficacy for COVID-19, treating providers have a need to know several questions including: Does a treatment remain effective as the pandemic wears on? Have we learned additional insights into the benefits of the therapy,” Robert L. Gottlieb MD, PhD, FACC, FAST, FIDSA, deputy editor for Baylor University Medical Center Proceedings, told Healio.

IDN1023Mozaffari_Graphic_01_WEB

Data derived from Mozzaffari E, et al. Open Forum Infect Dis. 2023;doi:10.1093/ofid/ofad482.

According to Gottlieb, these questions are typically answered through randomized controlled trials, which he said are considered “the gold standard” for doing so, and are complemented with real-world datasets. He added that for antiviral therapies, this allows researchers to answer the question of whether there is ongoing need for, and benefit from, each therapy.

“From laboratory studies, we understand that the SARS-CoV-2 virus can try to escape by acquiring better proofreading, but fortunately, we have also learned that the virus pays a ‘fitness cost’ for its extra attention to detail — the more attention to detail the virus replication machinery acquires, the slower this virus replicates,” he said. “Our examination of real-world data allows us to confirm that remdesivir maintains effectiveness as the pandemic has worn on through the middle of 2022 … This also allows us to show that even as the population has become increasingly vaccinated and/or recovered from prior bouts of COVID-19, remdesivir remains beneficial.”

To assess just how beneficial remdesivir can be, specifically for patients requiring supplemental oxygen, the researchers matched patients who were hospitalized for COVID-19 between December 2020 and April 2022 and received remdesivir upon admission 1:1 to patients not given remdesivir.

According to the study, analyses were stratified by supplemental oxygen requirement upon admission — low-flow oxygen (LFO), high-flow oxygen/noninvasive ventilation (HFO/NIV) or invasive mechanical ventilation/extracorporeal membrane oxygenation (IMV/ECMO) — and variant of concern (VOC) periods.

In total, 67,582 patients receiving LFO, 34,857 receiving HFO/NIV, and 4,164 receiving IMV/ECMO, all treated with remdesivir were matched. Overall, the study showed that unadjusted mortality rates were significantly lower for patients treated with remdesivir at day 14 (LFO: 6.4% vs. 8.8%; HFO/NIV: 16.8% vs. 19.4%; IMV/ECMO: 27.8% vs. 35.3%) and day 28 (LFO: 9.8% vs. 12.3%; HFO/NIV: 25.8% vs. 28.3%; IMV/ECMO: 41.4% vs. 50.6%).

In adjusted analyses, the researchers found that remdesivir treatment was associated with a statistically significant reduction in in-hospital mortality at day 14 (LFO: adjusted HR = 0.72; 95% CI, 0.66-0.79; HFO/NIV: aHR = 0.83; 95% CI, 0.77-0.89; IMV/ECMO: aHR = 0.73; 95% CI, 0.65-0.82) and day 28 (LFO: aHR = 0.79; 95% CI, 0.73-0.85; HFO/NIV: aHR = 0.88; 95% CI, 0.82-0.93; IMV/ECMO: aHR = 0.74; 95% CI, 0.67-0.82) compared with no remdesivir treatment.

They also found that this lower mortality risk was consistent among remdesivir-treated patients across all of the study’s VOC periods, although the authors noted that the association between remdesivir was most pronounced during the omicron wave.

“While it’s not a ‘magic bullet,’ particularly for these patients that present to this hospital already critically ill, every bit of help to improve survival is useful if you or your loved one is the patient,” Gottlieb said. “We now have this evidence: remdesivir use is associated with better survival from COVID-19, regardless of how sick someone is when they show up to our doorstep.”

“100 % of the antivirals not given don’t have the opportunity to work,” he said.Earlier in the pandemic, we had a limited supply of remdesivir, and we had to make each round of therapy be targeted to patients with the most to gain. We have not had any shortages of remdesivir since the first year of the pandemic, and our data support its use broadly for appropriate patients.”

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