Abstract
Objectives: To evaluate the effectiveness of remdesivir in the early stage of nonsevere COVID-19. Although several randomized controlled trials have compared the effectiveness of remdesivir with that of a placebo, there is limited evidence regarding its effect in the early stage of nonsevere COVID-19 cases.
Methods: We evaluated the effectiveness of remdesivir in the early stage of nonsevere COVID-19 using the COVID-19 Registry Japan, a nationwide registry of hospitalized patients with COVID-19 in Japan. Two regimens (“start remdesivir” therapy within 4 days from admission versus no remdesivir during hospitalization) among patients without the need for supplementary oxygen therapy were compared by a 3-step processing (cloning, censoring, and weighting) method. The primary outcome was a supplementary oxygen requirement during hospitalization. Secondary outcomes were 30-day in-hospital mortality and the risk of invasive mechanical ventilation or extracorporeal membrane oxygenation (IMV/ECMO). The data of 12,487 cases met our inclusion criteria. The “start remdesivir” regimen showed a lower risk of supplementary oxygen requirement (hazard ratio [HR]: 0.850, 95% confidence interval [CI]: 0.798-0.906, p value < 0.001). Both 30-day in-hospital mortality and risk of IMV/ECMO introduction were not significantly different between the 2 regimens (HRs: 1.04 and 0.983, 95% CI: 0.980-1.09 and 0.906-1.07, p values: 0.210 and 0.678, respectively).
Conclusions: Remdesivir might reduce the risk of oxygen requirement during hospitalization in the early stage of COVID-19; however, it had no positive effect on the clinical outcome and reduction in IMV/ECMO requirement.
Keywords: COVID-19; Inverse probability treatment weighting; Remdesivir.
【저자키워드】 COVID-19, Remdesivir, Inverse probability treatment weighting, 【초록키워드】 Randomized controlled trial, Treatment, therapy, Hospitalization, Remdesivir, risk, outcome, Clinical outcome, Probability, extracorporeal membrane oxygenation, Patient, Effectiveness, Japan, Placebo, registry, Admission, early stage, in-hospital mortality, Evidence, Invasive mechanical ventilation, COVID-19 cases, regimen, Primary outcome, 95% confidence interval, hazard ratio, inclusion criteria, lower risk, supplementary oxygen, positive, Oxygen requirement, Weighting, secondary, inverse, evaluate, evaluated, hospitalized patient, reduce, had no, reduction in, not significantly different, with COVID-19, 【제목키워드】 Hospitalized, Remdesivir, Japan, registry, patients with COVID-19,