Abstract
Background: Evidence remains inconclusive on any significant benefits of remdesivir in patients with mild-to-moderate COVID-19. This study explored the disease progression, various clinical outcomes, changes in viral load, and costs associated with early remdesivir treatment among COVID-19 patients.
Methods: A territory-wide retrospective cohort of 10 419 patients with COVID-19 hospitalized from 21 January 2020 to 31 January 2021 in Hong Kong was identified. Early remdesivir users were matched with controls using propensity-score matching in a ratio ≤1:4. Study outcomes were time to clinical improvement of at least 1 point on WHO clinical progression scale, hospital discharge, recovery, viral clearance, low viral load, positive IgG antibody, in-hospital death, and composite outcomes of in-hospital death requiring invasive ventilation or intensive care.
Results: After multiple imputation and propensity-score matching, median follow-up was 14 days for both remdesivir (n = 352) and control (n = 1347) groups. Time to clinical improvement was significantly shorter in the remdesivir group than that of control (HR: 1.14; 95% CI: 1.01-1.29; P = .038), as well as for achieving low viral load (1.51; 1.24-1.83; P < .001) and positive IgG antibody (1.50; 1.31-1.70; P < .001). Early remdesivir treatment was associated with lower risk of in-hospital death (HR: .58; 95% CI: .34-.99; P = .045), in addition to a significantly shorter length of hospital stay (difference: -2.56 days; 95% CI: -4.86 to -.26; P = .029), without increasing risks of composite outcomes for clinical deterioration.
Conclusions: Early remdesivir treatment could be extended to hospitalized patients with moderate COVID-19 not requiring oxygen therapy on admission.
Keywords: COVID-19; antiviral activity; clinical improvement; cost; remdesivir.
【저자키워드】 COVID-19, Remdesivir, antiviral activity, Clinical improvement, cost, 【초록키워드】 Treatment, Hospitalized, intensive care, Antiviral, Remdesivir, risk, oxygen, progression, antiviral activity, outcome, hospitalized patients, invasive ventilation, viral clearance, clinical outcomes, Moderate COVID-19, Disease progression, IgG antibody, Viral, Viral load, Patient, Control, Oxygen therapy, Clinical improvement, WHO, Follow-up, Hong Kong, Admission, COVID-19 patients, Clinical deterioration, Mild-to-moderate, Hospital stay, on admission, In-hospital death, multiple imputation, hospital discharge, lower risk, retrospective cohort, positive, study outcomes, Inconclusive, time, benefit, changes in viral load, addition, the disease, median, changes in, hospitalized patient, groups, patients with COVID-19, significantly shorter, 【제목키워드】 antiviral activity, activity, improvement, clinical,