Clinical outcomes of hospitalized COVID-19 patients treated with remdesivir: a retrospective analysis of a large tertiary care center in Germany

Abstract

Purpose The benefits of antiviral treatment with remdesivir in hospitalized patients with COVID-19 remain controversial. Clinical analyses are needed to demonstrate which patient populations are most likely to benefit. Methods In a retrospective monocentric analysis, patients with COVID-19 treated between July 1, 2020 and June 30, 2021 at Hospital St. Georg, Leipzig, Germany were evaluated. The primary endpoint was time to clinical improvement, and the secondary endpoint was 28-day mortality. Propensity score matching was used for the endpoint analysis. Results A total of 839 patients were fully evaluated, 68% of whom received specific COVID-19 drug therapy. Remdesivir was used in 31.3% of the patients, corticosteroids in 61.7%, and monoclonal antibodies in 2.3%. While dexamethasone administration was the most common therapeutic approach during the second pandemic wave, combination therapy with remdesivir and corticosteroids predominated during the third wave. Cox regression analysis revealed that combination therapy was not associated with faster clinical improvement (median: 13 days in both matched groups, HR 0.97 [95% CI 0.77–1.21], P = 0.762). By contrast, 28-day mortality was significantly lower in the corticosteroid-remdesivir group (14.8% versus 22.2% in the corticosteroid group, HR 0.60 [95% CI 0.39–0.95], P = 0.03) in the low-care setting. This effect was also demonstrated in a subgroup analysis of patients with remdesivir monotherapy (n = 44) versus standard of care (SOC). Conclusion In COVID-19 patients with only mild disease (low-flow oxygen therapy and treatment in a normal ward) who received corticosteroids and/or remdesivir in addition to SOC, early administration of remdesivir was associated with a measurable survival benefit.

Evaluation of Remdesivir for Mildly to Moderately Ill Patients with COVID-19: A Single-Arm, Single-Center, Retrospective Study

“…In contrast, patient III showed an early improvement when compared with patients II and IV, despite being obese (BMI = 35.2 kg/m 2 ). This may have been due to the fact that the period from symptom onset to RDV initiation was shorter when compared with patients II and IV, consistent with previous reports [17][18][19]. Additionally, Gottlieb et al showed that the early initiation of RDV in COVID-19 patients with risk factors decreased the composite of COVID-19-related hospitalization or all-cause mortality [20].…”

Tocilizumab vs. baricitinib in hospitalized severe COVID-19 patients: results from a real-world cohort

“…More patients in the tocilizumab group have been treated with remdesivir which can be explained by Remdesivir has shown to reduce progression to mechanical ventilation and mortality in several trials [9][10][11][12][13][14][15][16] and may have modified the potential effect of tocilizumab. When patients who received remdesivir were excluded from analysis there was a significantly lower mortality and a trend toward a shorter length of stay in the baricitinib group (for details see supplemental Table 2).…”

“…The two oral antivirals molnupiravir and nirmatrelvir/ritonavir have shown to reduce the combined endpoint hospitalization and death at day 29 significantly in outpatients at risk for severe disease when administered within 5 days of symptom onset [6,7]. The first available antiviral remdesivir which must be administered intravenously has shown to reduce the need for hospitalization in outpatients [8], progression to mechanical ventilation and in-hospital mortality in various observational [9][10][11][12] and randomized controlled trials (RCTs) [13][14][15][16]. Remdesivir seems to be most beneficial in patients with need for oxygen but not on mechanical ventilation [13,16].…”