Clinical Outcomes of COVID-19 Patients Treated with Convalescent Plasma or Remdesivir Alone and in Combination at a Community Hospital in California’s Central Valley

Abstract

Purpose: The purpose of this study was to compare how treatment with convalescent plasma (CP) monotherapy, remdesivir (RDV) monotherapy, and combination therapy (CP + RDV) in patients with COVID-19 affected clinical outcomes. Methods: Patients with COVID-19 infection who were admitted to the hospital received CP, RDV, or combination of both. Mortality, discharge disposition, hospital length of stay (LOS), intensive care unit (ICU) LOS, and total ventilation days were compared between each treatment group and stratified by ABO blood group. An exploratory analysis identified risk factors for mortality. Adverse effects were also evaluated. Results: RDV monotherapy showed an increased chance of survival compared to combination therapy or CP monotherapy (p = 0.052). There were 15, 3, and 6 deaths in the CP, RDV, and combination therapy groups, respectively. The combination therapy group had the longest median ICU LOS (8, IQR 4.5-15.5, p = 0.220) and hospital LOS (11, IQR 7-15.5, p = 0.175). Age (p = 0.036), initial SOFA score (p = 0.013), and intubation (p = 0.005) were statistically significant predictors of mortality. Patients with type O blood had decreased ventilation days, ICU LOS, and total LOS. Thirteen treatment-related adverse events occurred. Conclusion: No significant differences in clinical outcomes were observed between patients treated with RDV, CP, or combination therapy. Elderly patients, those with a high initial SOFA score, and those who require intubation are at increased risk of mortality associated with COVID-19. Blood type did not affect clinical outcomes.

The efficacy and safety of remdesivir alone and in combination with other drugs for the treatment of COVID-19: a systematic review and meta-analysis

“…In the meta-analysis of remdesivir combined with convalescent plasma, four studies [66][67][68][69] were included. In the meta-analysis of mortality, remdesivir combined with convalescent plasma did not have a significantly different effect compared to remdesivir alone (Additional file 5: Figure S6).…”

Clinical Efficacy and Safety of Antiviral Drugs in the Extended Use against COVID-19: What We Know So Far

“…In a real-life setting, the RDV regimen reduced hospitalization in both intubated (1.4 days lass) and non-intubated (3.4 days less) patients, although it was not statistically significant [41]. A study compared the efficacy of remdesivir, convalescent plasma, and a combination of both, which eventually revealed a higher survival rate in patients receiving RDV only [42]. In addition, several more randomized controlled clinical trials are undergoing to ensure the safety and efficacy of RDV against COVID-19.…”

The effect of remdesivir on mortality and the outcome of patients with COVID‐19 in intensive care unit: A case–control study

“…Numerous medications have been discovered so far to treat the coronavirus, but none of them have yet demonstrated efficacy. Remdesivir is one of these medicines that is frequently used 14 . The adenosine analog monophosphoramidite prodrug in question has a variety of antiviral effects, including activity against filoviruses, paramyxoviruses, pneumoviruses, and coronaviruses 15 .…”

“…Remdesivir is one of these medicines that is frequently used. 14 The adenosine analog monophosphoramidite prodrug in question has a variety of antiviral effects, including activity against filoviruses, paramyxoviruses, pneumoviruses, and coronaviruses. 15 Middle East respiratory syndrome (MERS) and SARS‐CoV are both inhibited by the viral RNA polymerase inhibitor Remdesivir.…”