Clinical Improvement, Outcomes, Antiviral Activity, and Costs Associated With Early Treatment With Remdesivir for Patients With Coronavirus Disease 2019 (COVID-19)

Abstract

Background Evidence remains inconclusive on any significant benefits of remdesivir in mild-to-moderate COVID-19 patients. This study explored the disease progression, various clinical outcomes, changes in viral load, and costs associated with early remdesivir treatment among COVID-19 patients. Methods A territory-wide retrospective cohort of 10,419 patients with COVID-19 hospitalized from 21st January 2020 to 31st January 2021 in Hong Kong were identified. Early remdesivir users were matched with controls using propensity-score matching in a ratio of up to 1:4. Study outcomes were time to clinical improvement on the WHO clinical progression scale of at least 1 score; hospital discharge; recovery; viral clearance; low viral load; positive IgG antibody; in-hospital death; and composite outcomes of in-hospital death, requiring invasive ventilation or intensive care. Results After multiple imputation and propensity-score matching, the median follow-up was 14 days for both remdesivir (n=352) and control (n=1,347) groups. Time to clinical improvement was significantly shorter in the remdesivir group than that of control (hazard ratio (HR)=1.14, 95%CI 1.01-1.29, p=0.038), as well as for achieving low viral load (HR=1.51, 95%CI 1.24-1.83, p<0.001) and positive IgG antibody (HR=1.50, 95%CI 1.31-1.70, p<0.001). Early remdesivir treatment was associated with a lower risk of in-hospital death (HR=0.58, 95%CI 0.34-0.99, p=0.045), in addition to a significantly shorter length of hospital stay (difference -2.56 days, 95%CI -4.86 to -0.26, p=0.029), without increasing the risks of composite outcomes for clinical deterioration. Conclusions Early remdesivir treatment could be extended to hospitalized patients presenting with moderate COVID-19 and not requiring oxygen therapy on admission.

Effect of Remdesivir on mortality and length of stay in hospitalized COVID-19 patients: A single center study

“…11 In fact, some data suggests the use of Remdesivir in non-hypoxic patients earlier in the course of the disease if there is evidence of COVID-19 pneumonia. 14 We did not identify any major side effects of Remdesivir in our patients. Maximum ALT and serum creatinine were not significantly raised.…”

“…We believe this group of patients were too late to receive Remdesivir, as has been discovered later in multiple studies, hence we were not able to see any improvement in outcomes. 14 However, the study is unique in being one of the first local reports on Remdesivir from our region where prospective data collection was done to follow patients for in-hospital mortality and side effects. Our recent data on the use of Remdesivir in non-hypoxic, moderate COVID pneumonia patients is soon to be published showing significant difference by the use of Remdesivir.…”

Remdesivir significantly reduces SARS‐CoV‐2 viral load on nasopharyngeal swabs in hospitalized patients with COVID‐19: A retrospective case–control study

“…On the contrary, Goldberg and colleagues evaluating 142 COVID‐19 patients, 29 of them treated with remdesivir, did not find any difference on VL between the two groups 12 . Moreover, a retrospective propensity score matched cohort study evaluating 1699 patients (352 treated with remdesivir) evidenced a significant effect on the reduction of VL, length of hospital stay and death rate 17 . Finally, Barrat and colleagues evaluated 181 patients, 42 of whom treated with remdesivir, compared to 52 treated with hydroxychloroquine and 87 with standard care.…”

“… 12 Moreover, a retrospective propensity score matched cohort study evaluating 1699 patients (352 treated with remdesivir) evidenced a significant effect on the reduction of VL, length of hospital stay and death rate. 17 Finally, Barrat and colleagues evaluated 181 patients, 42 of whom treated with remdesivir, compared to 52 treated with hydroxychloroquine and 87 with standard care. No differences in terms of VL decay and mortality rate were found among the three groups.…”

Slower Recovery with Early Lopinavir/Ritonavir use in Pediatric COVID-19 Patients: A Retrospective Observational Study

“…Early on during the pandemic in Hong Kong, LPV/r was used as a part of triple therapy for early treatment of COVID-19, consisting of interferon-β-1b and LPV/r ± ribavirin [ 41 ]. Additional to LPV/r, dexamethasone and remdesivir have been commonly used in patients with mild-to-moderate symptoms [ 42 – 45 ].…”