Abstract
Background: Remdesivir (RDV) improved clinical outcomes among hospitalized patients with coronavirus disease 2019 (COVID-19) in randomized trials, but data from clinical practice are limited.
Methods: We examined survival outcomes for US patients hospitalized with COVID-19 between August and November 2020 and treated with RDV within 2 days of hospitalization vs those not receiving RDV during their hospitalization using the Premier Healthcare Database. Preferential within-hospital propensity score matching with replacement was used. Additionally, patients were also matched on baseline oxygenation level (no supplemental oxygen charges [NSO], low-flow oxygen [LFO], high-flow oxygen/noninvasive ventilation [HFO/NIV], and invasive mechanical ventilation/extracorporeal membrane oxygenation [IMV/ECMO]) and 2-month admission window and excluded if discharged within 3 days of admission (to exclude anticipated discharges/transfers within 72 hours, consistent with the Adaptive COVID-19 Treatment Trial [ACTT-1] study). Cox proportional hazards models were used to assess time to 14-/28-day mortality overall and for patients on NSO, LFO, HFO/NIV, and IMV/ECMO.
Results: A total of 28855 RDV patients were matched to 16687 unique non-RDV patients. Overall, 10.6% and 15.4% RDV patients died within 14 and 28 days, respectively, compared with 15.4% and 19.1% non-RDV patients. Overall, RDV was associated with a reduction in mortality at 14 days (hazard ratio [95% confidence interval]: 0.76 [0.70-0.83]) and 28 days (0.89 [0.82-0.96]). This mortality benefit was also seen for NSO, LFO, and IMV/ECMO at 14 days (NSO: 0.69 [0.57-0.83], LFO: 0.68 [0.80-0.77], IMV/ECMO: 0.70 [0.58-0.84]) and 28 days (NSO: 0.80 [0.68-0.94], LFO: 0.77 [0.68-0.86], IMV/ECMO: 0.81 [0.69-0.94]). Additionally, HFO/NIV RDV group had a lower risk of mortality at 14 days (0.81 [0.70-0.93]) but no statistical significance at 28 days.
Conclusions: RDV initiated upon hospital admission was associated with improved survival among patients with COVID-19. Our findings complement ACTT-1 and support RDV as a foundational treatment for hospitalized COVID-19 patients.
Keywords: COVID-19; comparative effectiveness research; hospitalization; mortality; remdesivir.
【저자키워드】 COVID-19, Mortality, Hospitalization, remdesivir., comparative effectiveness research, 【초록키워드】 Treatment, coronavirus disease, Ventilation, Remdesivir, complement, outcome, Clinical outcome, survival, Patient, Effectiveness, membrane, Hospital admission, Admission, patients, Clinical practice, RDV, propensity score matching, Oxygenation, Support, supplemental oxygen, randomized trials, hospitalized COVID-19 patients, hazard ratio, statistical significance, lower risk, low-flow oxygen, reduction in mortality, benefit, was used, examined, receiving, treated, were used, unique, hospitalized patient, initiated, excluded, discharged, anticipated, baseline, Cox proportional hazard, invasive mechanical, patients died, patients hospitalized, patients with COVID-19, with COVID-19, 【제목키워드】 Comparative,