Remdesivir Recommended for Inpatients With COVID-19 on Supplemental Oxygen

Treatment with remdesivir significantly decreases the risk for mortality in patients hospitalized with COVID-19 who require supplemental oxygen, according to study results published in Open Forum Infectious Diseases.

Researchers performed a retrospective study to assess the effects of remdesivir on the risk for in-hospital mortality among patients with severe COVID-19 infection receiving supplemental oxygen. Data were captured from adult patients who were hospitalized between December 2020 and April 2022. The primary outcome was all-cause in-hospital mortality at 14 and 28 days. The researchers used 1:1 propensity score matching to compare outcomes between patients with vs without reported remdesivir use during hospitalization.

Logistic regression models were used to assess outcomes separately by variant-specific periods (pre-Delta, Delta, and Omicron) and type of oxygen supplementation required at baseline, including low-flow oxygen, high-flow oxygen/noninvasive mechanical ventilation (IMV), and IMV/extracorporeal membrane oxygenation (ECMO). Models were adjusted for patient demographics, hospital characteristics, COVID-19 severity, concomitant treatments, comorbidities, and month of admission.

Among patients with and without reported remdesivir use included in the final matched analysis, 67,582 and 18,830 required low-flow oxygen, 34,857 and 10,189 required high-flow oxygen/non-IMV, and 4164 and 1880 required IMV/ECMO, respectively.

At day 14, in-hospital mortality rates were lower across all variant-specific periods for patients with vs without reported remdesivir use who required low-flow oxygen (6.4% vs 8.8%). Lower in-hospital rates were also observed among remdesivir recipients in the high-flow oxygen/non-IMV group (16.8% vs 19.4%) and the IMV/EMCO group (27.8% vs 35.3%).

Similar findings were noted at day 28, with lower in-hospital mortality rates observed across all variant-specific periods for remdesivir recipients in the low-flow oxygen group (9.8% vs 12.3%), high-flow oxygen/non-IMV group (25.8% vs 28.3%), and the IMV/ECMO group (41.4% vs 50.6%).

In adjusted analyses, remdesivir use was significantly associated with reduced risk for in-hospital mortality at 14 days among all patient groups, including those who required low-flow oxygen (adjusted hazard ratio [aHR], 0.72; 95% CI, 0.66-0.79), high-flow oxygen/non-IMV (aHR, 0.83; 95% CI, 0.77-0.89), and IMV/ECMO (aHR, 0.73; 95% CI, 0.65-0.82).

The relationship between remdesivir use and significantly reduced risk for in-hospital mortality was also observed at day 28 among all patient groups.

Limitations of this study include potential residual confounding and subsequent indication bias, the lack of data on COVID-19 vaccination status, the lack of data on treatments used prior to hospitalization, and potential systematic differences patients with vs without reported remdesivir use.

“Based on current evidence, remdesivir should be administered as soon as possible in patients hospitalized for COVID-19 to prevent progression to severe or critical disease,” the researchers concluded.

Disclosures: Multiple study authors declared affiliations with pharmaceutical, biotech, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Infectious Disease Advisor