Carlos K H Wong1,2, Kristy T K Lau1, Ivan C H Au2, Xi Xiong1, Eric H Y Lau3,4, Benjamin J Cowling3,4. 1. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region (SAR), China. 2. Department of Family Medicine and Primary Care, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China. 3. WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China. 4. Laboratory of Data Discovery for Health Limited, Hong Kong Science Park, New Territories, Hong Kong SAR, China.
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.
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.
Authors: Vincenzo Spagnuolo; Marta Voarino; Marco Tonelli; Laura Galli; Andrea Poli; Elena Bruzzesi; Sara Racca; Nicola Clementi; Chiara Oltolini; Moreno Tresoldi; Patrizia Rovere Querini; Lorenzo Dagna; Alberto Zangrillo; Fabio Ciceri; Massimo Clementi; Antonella Castagna Journal: Drug Des Devel Ther Date: 2022-10-19 Impact factor: 4.319
Authors: Carlos K H Wong; Kristy T K Lau; Ivan C H Au; Xi Xiong; Matthew S H Chung; Belle Y C Leung; Eric H Y Lau; Benjamin J Cowling Journal: Front Pharmacol Date: 2022-05-30 Impact factor: 5.988
Authors: Carlos K H Wong; Ivan C H Au; Wing Yiu Cheng; Kenneth K C Man; Kristy T K Lau; Lung Yi Mak; Sing Leung Lui; Matthew S H Chung; Xi Xiong; Eric H Y Lau; Benjamin J Cowling Journal: Aliment Pharmacol Ther Date: 2022-03-22 Impact factor: 9.524
Authors: Carlos K H Wong; Marshall C H Low; Ashley C Y Kwok; Angel Y C Lui; Kristy T K Lau; Ivan C H Au; Xi Xiong; Matthew S H Chung; Mike Y W Kwan; Eric H Y Lau; Benjamin J Cowling Journal: Paediatr Drugs Date: 2022-04-16 Impact factor: 3.930
Authors: Carlos K H Wong; Ivan C H Au; Kristy T K Lau; Eric H Y Lau; Benjamin J Cowling; Gabriel M Leung Journal: Lancet Infect Dis Date: 2022-08-24 Impact factor: 71.421
Authors: Annalucia Biancofiore; Antonio Mirijello; Maria A Puteo; Maria P Di Viesti; Maria Labonia; Massimiliano Copetti; Salvatore De Cosmo; Renato Lombardi Journal: J Med Virol Date: 2022-01-28 Impact factor: 20.693