Remdesivir is Associated with Reduced Mortality in Patients Hospitalized for COVID-19 Not Requiring Supplemental Oxygen

Essy Mozaffari; Aastha Chandak; Chidinma Chima-Melton; Andre C Kalil; Heng Jiang; EunYoung Lee; Celine Der-Torossian; Mark Thrun; Mark Berry; Richard Haubrich; Robert L Gottlieb

doi:10.1093/ofid/ofae202

Remdesivir is Associated with Reduced Mortality in Patients Hospitalized for COVID-19 Not Requiring Supplemental Oxygen

Open Forum Infect Dis. 2024 Apr 16;11(6):ofae202. doi: 10.1093/ofid/ofae202. eCollection 2024 Jun.

Authors

Affiliations

¹ Medical Affairs, Gilead Sciences, Foster City, California, USA.
² Evidence & Access, Certara, New York, New York, USA.
³ Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of California-Los Angeles Health, Torrance, California, USA.
⁴ Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.
⁵ Evidence & Access, Certara, Paris, France.
⁶ Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA.
⁷ Baylor Scott & White Research Institute, Dallas, Texas, USA.
⁸ Department of Internal Medicine, Burnett School of Medicine at TCU, Fort Worth, Texas, USA.
⁹ Department of Internal Medicine, Texas A&M Health Science Center, Dallas, Texas, USA.

Abstract

Background: Remdesivir has demonstrated benefit in some hospitalized patients with coronavirus disease 2019 (COVID-19) on supplemental oxygen and in nonhospitalized patients breathing room air. The durability of this benefit across time periods with different circulating severe acute respiratory syndrome coronavirus 2 variants of concern (VOC) is unknown. This comparative effectiveness study in patients hospitalized for COVID-19 and not receiving supplemental oxygen at admission compared those starting remdesivir treatment in the first 2 days of admission with those receiving no remdesivir during their hospitalization across different VOC periods.

Method: Using a large, multicenter US hospital database, in-hospital mortality rates were compared among patients hospitalized for COVID-19 but not requiring supplemental oxygen at admission between December 2020 and April 2022. Patients receiving remdesivir at hospital admission were matched 1:1 to those not receiving remdesivir during hospitalization, using propensity score matching. Cox proportional hazards models were used to assess 14- and 28-day in-hospital mortality rates or discharge to hospice.

Results: Among the 121 336 eligible patients, 58 188 remdesivir-treated patients were matched to 17 574 unique patients not receiving remdesivir. Overall, 5.4% of remdesivir-treated and 7.3% in the non-remdesivir group died within 14 days, and 8.0% and 9.8%, respectively, died within 28 days. Remdesivir treatment was associated with a statistically significant reduction in the in-hospital mortality rate compared with non-remdesivir treatment (14-day and 28-day adjusted hazard ratios [95% confidence interval], 0.75 [0.68-0.83] and 0.83 [0.76-0.90], respectively). This significant mortality benefit endured across the different VOC periods.

Conclusions: Remdesivir initiation in patients hospitalized for COVID-19 and not requiring supplemental oxygen at admission was associated with a significantly reduced in-hospital mortality rate. These findings highlight a potential survival benefit when clinicians initiated remdesivir on admission across the dominant variant eras of the evolving pandemic.

Keywords: COVID-19; comparative effectiveness research; hospitalization; mortality; remdesivir.