Association of Remdesivir Treatment With Mortality Among Hospitalized Adults With COVID-19 in the United States

Abstract

ImportanceSARS-CoV-2, which causes COVID-19, poses considerable morbidity and mortality risks. Studies using data collected during routine clinical practice can supplement randomized clinical trials to provide needed evidence, especially during a global pandemic, and can yield markedly larger sample sizes to assess outcomes for important patient subgroups.ObjectiveTo evaluate the association of remdesivir treatment with inpatient mortality among patients with COVID-19 outside of the clinical trial setting.Design, Setting, and ParticipantsA retrospective cohort study in US hospitals using health insurance claims data linked to hospital chargemaster data from December 1, 2018, to May 3, 2021, was conducted among 24 856 adults hospitalized between May 1, 2020, and May 3, 2021, with newly diagnosed COVID-19 who received remdesivir and 24 856 propensity score–matched control patients.ExposureRemdesivir treatment.Main Outcomes and MeasuresAll-cause inpatient mortality within 28 days of the start of remdesivir treatment for the remdesivir-exposed group or the matched index date for the control group.ResultsA total of 24 856 remdesivir-exposed patients (12 596 men [50.7%]; mean [SD] age, 66.8 [15.4] years) and 24 856 propensity score–matched control patients (12 621 men [50.8%]; mean [SD] age, 66.8 [15.4] years) were included in the study. Median follow-up was 6 days (IQR, 4-11 days) in the remdesivir group and 5 days (IQR, 2-10 days) in the control group. There were 3557 mortality events (14.3%) in the remdesivir group and 3775 mortality events (15.2%) in the control group. The 28-day mortality rate was 0.5 per person-month in the remdesivir group and 0.6 per person-month in the control group. Remdesivir treatment was associated with a statistically significant 17% reduction in inpatient mortality among patients hospitalized with COVID-19 compared with propensity score–matched control patients (hazard ratio, 0.83 [95% CI, 0.79-0.87]).Conclusions and RelevanceIn this retrospective cohort study using health insurance claims and hospital chargemaster data, remdesivir treatment was associated with a significantly reduced inpatient mortality overall among patients hospitalized with COVID-19. Results of this analysis using data collected during routine clinical practice and state-of-the-art methods complement results from randomized clinical trials. Future areas of research include assessing the association of remdesivir treatment with inpatient mortality during the circulation of different variants and relative to time from symptom onset.

Clinical evidence of the effectiveness of remdesivir in COVID-19 during periods dominated by Delta and Omicron SARS-CoV-2 variants.

“…These observations are consistent with the results from clinical trials and RWE studies conducted in the early phases of the COVID-19 pandemic 27,[37][38][39] . A retrospective analysis of a large U.S. patient cohort of nearly 100,000 patients hospitalized till February 2021 also confirmed a reduction in mortality in the overall population treated with RDV in absolute numbers (15.7 vs. 19.6%), but highlighted a significant difference only in patients who required low-flow oxygen therapy 40 .…”

Retrospective Analysis of the Effectiveness of Remdesivir in COVID-19 Treatment during Periods Dominated by Delta and Omicron SARS-CoV-2 Variants in Clinical Settings

“…These observations are consistent with results from clinical trials and RWE studies conducted in the early phases of the COVID-19 pandemic [ 22 , 48 , 49 , 50 ]. A retrospective analysis of a large U.S. patient cohort of nearly 100,000 patients hospitalized until February 2021 also confirmed a reduction in mortality in the overall population treated with RDV in absolute numbers (15.7 vs. 19.6%) but highlighted a significant difference only in patients who required low-flow oxygen therapy [ 51 ].…”

Remdesivir saves lives. Were 3 years needed to learn that?

“…Notably, these results confirm the findings of ACTT-1 that were reported in April, 2020. 2 Additionally, it should not be surprising that if remdesivir significantly reduced mortality in patients receiving supplemental oxygen, 2 patients given remdesivir earlier in the course of COVID-19 should also benefit: such findings were shown by the Solidarity trial 7 and this meta-analysis 1 (significantly better survival and lower progression to mechanical ventilation or death in hospitalised patients with or without supplemental oxygen); by multiple large, real-world, comparative effectiveness studies from different countries 8 , 9 , 10 , 11 (significantly better survival and clinical recovery in hospitalised patients without supplemental oxygen); and by the PINETREE trial 12 (significantly lower progression to hospitalisation or death in outpatients at high risk without supplemental oxygen).…”