Remdesivir for COVID-19 Lowers Mortality in Immunocompromised Patients

Among patients with immunocompromising conditions who were hospitalized for COVID-19, remdesivir was linked to significantly improved survival, according to study findings published in Clinical Infectious Diseases.

Researchers conducted a retrospective comparative effectiveness study to investigate the effect of remdesivir use in patients with immunocompromising conditions who were infected with COVID-19. Data were sourced from the US PINC AI Healthcare Database to identify adults with immunocompromising conditions who were hospitalized with COVID-19 between December 2021 and February 2024. Patients who received remdesivir were matched 1:1 to those who did not receive remdesivir. The primary outcome was all-cause inpatient mortality at 14- and 28-days postbaseline. Subgroup analyses were conducted in patients with cancer, hematologic malignancies, leukemia, lymphoma, multiple myeloma, and solid organ/hematopoietic stem cell transplant recipients. Cox proportional hazard models were used to evaluate the association between remdesivir and inpatient mortality at both timepoints.

A total of 28,966 patients were included in the study, of whom 16,730 (58%) received remdesivir. After matching, the cohort comprised 8822 (aged ≥65 years, 77%; women, 51.1%; White, 77%; non-Hispanic, 86%) remdesivir and nonremdesivir matched pairs. The most prevalent comorbidities included cardiovascular disease (90%), cancer (43%), and chronic obstructive pulmonary disease (39%). The most common immunocompromising conditions were cancers, use of immunosuppressive medications, and primary immunodeficiencies.

The unadjusted all-cause inpatient mortality rates at 14 and 28 days were 9.2% and 12.7% among remdesivir recipients and 11.8% and 15.4% among those who did not receive remdesivir, respectively.

Overall, remdesivir was associated with significantly reduced all-cause inpatient mortality at 14 (adjusted hazard ratio [aHR], 0.75; 95% CI, 0.68-0.83; P <.0001) and 28 (aHR, 0.78; 95% CI, 0.72-0.86; P <.0001) days.

The association between remdesivir and reduced risk of mortality at 14 and 28 days remained consistent among patients who did (aHR range, 0.75-0.78) and did not (aHR range, 0.73-0.79) receive any oxygen support at baseline.

Stratified by immunocompromising condition, remdesivir was associated with lower risk of mortality at 14 days among patients with multiple myeloma (aHR, 0.39; 95% CI, 0.25-0.61), leukemia (aHR, 0.61; 95% CI, 0.47-0.79), hematologic malignancy (aHR, 0.62; 95% CI, 0.52-0.74), and solid organ or hematopoietic stem cell transplant (aHR, 0.64; 95% CI, 0.44-0.95).

Similarly, remdesivir was associated with lower risk of mortality at 28 days among patients with multiple myeloma (aHR, 0.41; 95% CI, 0.28-0.61), hematologic malignancy (aHR, 0.64; 95% CI, 0.54-0.74), leukemia (aHR, 0.65; 95% CI, 0.51-0.83), solid organ or hematopoietic stem cell transplant (aHR, 0.65; 95% CI, 0.48-0.87), and lymphoma (aHR, 0.72; 95% CI, 0.56-0.92).

This study was limited by not having access to data about time since symptom onset, time since positive test, or vaccination status.

“To harmonize and optimize the management of patients with immunocompromising conditions hospitalized for COVID-19 across clinical settings, it is essential to incorporate the most recent evidence garnered from routine clinical practice into major infectious disease guidelines,” the researchers concluded.

Disclosure: This research was supported by Gilead Sciences, Inc. Some study authors reported affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures

This article originally appeared on Infectious Disease Advisor