Remdesivir Use in Patients Requiring Mechanical Ventilation due to COVID-19

Abstract

Background Remdesivir has been associated with accelerated recovery of severe COVID-19. However, whether it is beneficial also in patients requiring mechanical ventilation is uncertain. Methods All consecutive ICU patients requiring mechanical ventilation due to COVID-19 were enrolled. Univariate and multivariable Cox models were used to explore the possible association between in-hospital death or hospital discharge, considered as competing-risk events, and baseline or treatment-related factors, including the use of remdesivir. The rate of extubation and the number of ventilator-free days were also calculated and compared between treatment groups. Results 113 patients requiring mechanical ventilation were observed for a median of 31 days of follow-up; 32% died, 69% were extubated and 66% were discharged alive from hospital. Among 33 treated with RDV, lower mortality (15.2% versus 38.8%), higher rates of extubation (88% versus 60%), ventilator-free days (in median, 11 [IQR 0-16] versus 5 [IQR 0-14.5]) and hospital discharge (85% versus 59%) were observed. Using multivariable analysis, RDV was significantly associated with hospital discharge (HR 2.25; 95%CI 1.27-3.97; P=0.005) and to a non-significantly lower mortality (HR 0.73; 95%CI 0.26-2.1; P=0.560). RDV was also independently associated with extubation (HR 2.10; 95%CI 1.19-3.73; P=0.011), considered as a competing risk to death in ICU, in an additional survival model. Conclusion In our cohort of mechanically ventilated patients, RDV was not associated with a significant reduction of mortality, but it was consistently associated with shorter duration of mechanical ventilation and higher probability of hospital discharge, independently of other risk factors.

Efficacy and Safety of Remdesivir in COVID-19 Patients: A Retrospective Analysis of Active Surveillance Database

“…In this retrospective analysis of data from an active surveillance programme, we assessed e cacy and safety of remdesivir by measuring the clinical outcomes (cure, improvement, no improvement, or death) in hospitalised patients with COVID-19 who were treated with remdesivir, and their subgroups. The cure/improvement rate was 84%, which is in accordance with the cure/improvement reported in historical cohorts [8][9][10][11][12][13][14][15]. Most patients were male, were in the age group of 40-60 years, required oxygen therapy, and received remdesivir for 5 days.…”

Cost utility analysis of Remdesivir and Dexamethasone treatment for hospitalised COVID-19 patients - a hypothetical study

“…In the latter study, however, the trial has not been designed to primarily test the time to recovery [ 39 ]. Moreover, other observational studies have shown the benefits of Remdesivir even for ventilated patients [ 40 , 41 ]. Next, hospital costs where assumed to be related at some extend to the patients length of stay.…”

Methodological evaluation of bias in observational coronavirus disease 2019 studies on drug effectiveness

“…As a result, the competing risk analysis showed that remdesivir was significantly associated with hospital discharge (hazard ratio, 2.25; 95%CI 1.27-3.97) and with a non-significantly lower mortality (hazard ratio, 0.73; 95%CI 0.26-2.1). Moreover, the cumulative hazard plots were used to visualize potential treatment effects [44]. This example addresses all three methodological biases and clearly demonstrates the need to study competing events.…”