Impact of Remdesivir on SARS-CoV-2 Clearance in a Real-Life Setting: A Matched-Cohort Study

Abstract

Background Evidence regarding the impact of remdesivir (RDV) on SARS-CoV-2 viral clearance (VC) is scarce. The aim of this study was to compare VC timing in hospitalized COVID-19 patients who did or did not receive RDV. Methods This was a matched-cohort study of patients hospitalized with pneumonia, a SARS-CoV-2-positive nasopharyngeal swab (NPS) at admission, and at least one NPS during follow-up. Patients who received RDV (cases) and those who did not (controls) were matched in a 1:2 ratio by age, sex, and PaO 2 /FiO 2 (P/F) values at admission. NPSs were analyzed using real-time polymerase chain reaction. Time to VC (within 30 days after hospital discharge) was estimated using the Kaplan–Meier curve. A multivariable Cox proportional hazard model was fitted to determine factors associated with VC. Results There were 648 patients enrolled in the study (216 cases and 432 controls). VC was observed in 490 patients (75.6%), with a median time of 25 (IQR 16–34) days. Overall, time to VC was similar between cases and controls (p = 0.519). However, time to VC was different when considering both RDV treatment status and age (p = 0.007). A significant finding was also observed when considering both RDV treatment status and P/F values at admission (p = 0.007). A multivariate analysis showed that VC was associated with a younger age (aHR = 0.990, 95% CI 0.983–0.998 per every 10-year increase in age; p = 0.009) and a higher baseline P/F ratio (aHR=1.275, 95% CI 1.029–1.579; p=0.026), but not with RDV treatment status. Conclusion Time to VC was similar in cases and controls. However, there was a benefit associated with using RDV in regard to time to VC in younger patients and in those with a P/F ratio ≤200 mmHg at hospital admission.

Risk of hospitalization and sequelae in patients with COVID‐19 treated with 3‐day early remdesivir vs. controls in the vaccine and Omicron era: A real‐life cohort study

“…According to these results, regulatory agencies approved this modality of treatment, which soon became extensively employed. Even if limited by low numbers of patients included, emerging real‐life data on 3‐day remdesivir treatment course demonstrated a significant reduction of hospitalization risk, which set closely to risk reduction reported by registration clinical trials and showed also reduction of viral SARS‐CoV‐2 positivity 25–31 . However, most of these experiences ‐had a small sample size and often importantly limited by the lack of a control group 25–31 …”

“…Even if limited by low numbers of patients included, emerging reallife data on 3-day remdesivir treatment course demonstrated a significant reduction of hospitalization risk, which set closely to risk reduction reported by registration clinical trials and showed also reduction of viral SARS-CoV-2 positivity. [25][26][27][28][29][30][31] However, most of these experiences -had a small sample size and often importantly limited by the lack of a control group. [25][26][27][28][29][30][31] Therefore, in this study we aimed at assessing the real-life effectiveness of a 3-day course of remdesivir, administered in the outpatient's clinic, in a cohort of patients with COVID-19 at high risk of COVID-19 progression in comparison with a cohort of patients who did not receive the antiviral treatment despite being eligible (controls).…”

“…[25][26][27][28][29][30][31] However, most of these experiences -had a small sample size and often importantly limited by the lack of a control group. [25][26][27][28][29][30][31] Therefore, in this study we aimed at assessing the real-life effectiveness of a 3-day course of remdesivir, administered in the outpatient's clinic, in a cohort of patients with COVID-19 at high risk of COVID-19 progression in comparison with a cohort of patients who did not receive the antiviral treatment despite being eligible (controls).…”

Remdesivir Use in the Real-World Setting: An Overview of Available Evidence

“…A retrospective single-center cohort study showed a significantly lower ( p = 0.001) mortality rate when RDV infusion started within 6 days of symptoms, while there was no significant difference when symptom duration exceeded 6 days [ 25 ]. Early administration of a 5-day course of remdesivir (within two days of admission) was associated with a significantly shorter time to clinical improvement, lower viral load [ 26 ] and positive IgG antibodies, reduced length of hospital stay, and lower risk of in-hospital death [ 27 ]. In another retrospective single-center study, the threshold of clinical benefit was set to 9 days from symptom onset for the initiation of RDV when significantly lower all-cause mortality was documented ( p = 0.004) [ 28 ].…”