Impact of Remdesivir on the Treatment of COVID-19 During the First Wave in Spain

Abstract

Introduction Spain was one of the most affected countries during the first wave of COVID-19, having the highest mortality rate in Europe. The aim of this retrospective study is to estimate the impact that remdesivir—the first drug for COVID-19 approved in the EU—would have had in the first wave. Methods This study simulated the impact that remdesivir could have had on the Spanish National Health System (SNHS) capacity (bed occupancy) and the number of deaths that could have been prevented, based on two scenarios: a real-life scenario (without remdesivir) and an alternative scenario (with remdesivir). It considered the clinical results of the ACTT-1 trial in hospitalized patients with COVID-19 and pneumonia who required supplemental oxygen. The occupancy rates in general wards and ICUs were estimated in both scenarios. Results Remdesivir use could have prevented the admission of 2587 patients (43.75%) in the ICUs. It could have also increased the SNHS capacity in 5656 general wards beds and 1700 ICU beds, showing an increase in the number of beds available of 17.53% (95% CI 3.98%–24.42%) and 23.98% (95% CI 21.33%–28.22%), respectively, at the peak of the occupancy rates. Furthermore, remdesivir use could have prevented 7639 deaths due to COVID-19, which implies a 27.51% reduction (95% CI 14.25%–34.07%). Conclusions Remdesivir could have relieved the pressure on the SNHS and could have reduced the death toll, providing a better strategy for the management of COVID-19 during the first wave. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01804-9.

Co-Administration of Remdesivir and Azithromycin May Protect against Intensive Care Unit Admission in COVID-19 Pneumonia Requiring Hospitalization: A Real-Life Observational Study

“…The severity of clinical presentation of COVID-19 patients during the second and third pandemic wave in 2020–2021, before the completion of mass vaccination campaigns, and the absence of specific and effective drugs against SARS-CoV-2, have made remdesivir administration particularly frequent in the hospital setting, despite the absence of clear advantages against mortality. To date, real-life studies have provided conflicting results, with some reports suggesting clear benefits from remdesivir administration, and other yielding negative results [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ].…”

“…On the other side, the reduced need of ICU admission in patients who were treated with both remdesivir and azithromycin suggests that the clinical benefits of remdesivir could be reinforced by the administration of other drugs exhibiting anti-SARS-CoV-2 activity in vitro, like azithromycin. Also, it may contribute to explain why real-life studies on remdesivir efficacy have produced conflicting results [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ].…”

“…Some reports have shown little or no impact from this treatment, either alone or in association with steroids, on clinically relevant outcomes such as intensive care unit (ICU) admission or mortality [ 7 , 8 , 9 , 10 ]. Conversely, other studies suggested that it could be useful, as an add-on treatment, in adults with persistent fever and dyspnea and moderate lung involvement on chest CT, reducing ICU admission, length of hospital stay, and even mortality [ 11 , 12 , 13 , 14 , 15 ], especially when administered in the first 5 days of symptoms [ 15 ].…”

Remdesivir-related cost-effectiveness and cost and resource use evidence in COVID-19: a systematic review

“…Of these, three studies used 2020 US Dollars [ 28 , 30 , 37 ], one study used Euros (cost year not reported) [ 34 ], and one study used 2020 Chinese Yuan (CN¥) [ 35 ] in cost calculations. Most studies either used a healthcare system perspective ( n = 4) [ 28 , 32 , 34 , 35 ], or an individual hospital perspective ( n = 3) [ 27 , 31 , 33 ].…”

Use of Antivirals in SARS-CoV-2 Infection. Critical Review of the Role of Remdesivir

“…Overall, it has been predicted that the use of remdesivir during the first wave of COVID-19 in Spain would have prevented 7639 deaths – a reduction of 27.51% ( 95% CI : 14.25–34.07%). 62 The World Health Organization (WHO) conducted a different randomized open-label non placebo controlled clinical trial of 4 antiviral drugs (remdesivir, hydroxychloroquine, lopinavir and interferon β-1a), involving 405 hospitals in 30 countries. The results in this case showed that remdesivir ( RR : 0.95 [ 95% CI , 0.81–1.11]) and the other compounds had little or no effect on overall mortality, initiation of ventilation, or duration of hospitalization; 27 however, patients in this study were stratified by need for respiratory support instead of the method used in other clinical trial (disease severity).…”