Brian T Garibaldi1,2, Kunbo Wang2,3, Matthew L Robinson2,4, Joshua Betz2,5, G Caleb Alexander2,6,7, Kathleen M Andersen2,6,7, Corey S Joseph2,6,7, Hemalkumar B Mehta2,6,7, Kimberly Korwek2,8, Kenneth E Sands2,8, Arielle M Fisher2,9, Robert C Bollinger2,4, Yanxun Xu2,3,10. 1. Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 2. COVID-19 Consortium of HCA Healthcare and Academia for Research GEneration, Nashville, Tennessee, USA. 3. Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, Maryland, USA. 4. Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 5. Division of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. 6. Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. 7. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. 8. Clinical Operations Group, HCA Healthcare, Nashville, Tennessee, USA. 9. Genospace, Sarah Cannon, Boston, Massachusetts, USA. 10. Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Abstract
BACKGROUND: There is an urgent need to understand the real-world effectiveness of remdesivir in the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: This was a retrospective comparative effectiveness study. Individuals hospitalized in a large private healthcare network in the United States from 23 February 2020 through 11 February 2021 with a positive test for SARS-CoV-2 and ICD-10 diagnosis codes consistent with symptomatic coronavirus disease 2019 (COVID-19) were included. Remdesivir recipients were matched to controls using time-dependent propensity scores. The primary outcome was time to improvement with a secondary outcome of time to death. RESULTS: Of 96 859 COVID-19 patients, 42 473 (43.9%) received at least 1 remdesivir dose. The median age of remdesivir recipients was 65 years, 23 701 (55.8%) were male, and 22 819 (53.7%) were non-White. Matches were found for 18 328 patients (43.2%). Remdesivir recipients were significantly more likely to achieve clinical improvement by 28 days (adjusted hazard ratio [aHR] 1.19, 95% confidence interval [CI], 1.16-1.22). Remdesivir patients on no oxygen (aHR 1.30, 95% CI, 1.22-1.38) or low-flow oxygen (aHR 1.23, 95% CI, 1.19-1.27) were significantly more likely to achieve clinical improvement by 28 days. There was no significant impact on the likelihood of mortality overall (aHR 1.02, 95% CI, .97-1.08). Remdesivir recipients on low-flow oxygen were significantly less likely to die than controls (aHR 0.85, 95% CI, .77-.92; 28-day mortality 8.4% [865 deaths] for remdesivir patients, 12.5% [1334 deaths] for controls). CONCLUSIONS: These results support the use of remdesivir for hospitalized COVID-19 patients on no or low-flow oxygen. Routine initiation of remdesivir in more severely ill patients is unlikely to be beneficial.
BACKGROUND: There is an urgent need to understand the real-world effectiveness of remdesivir in the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: This was a retrospective comparative effectiveness study. Individuals hospitalized in a large private healthcare network in the United States from 23 February 2020 through 11 February 2021 with a positive test for SARS-CoV-2 and ICD-10 diagnosis codes consistent with symptomatic coronavirus disease 2019 (COVID-19) were included. Remdesivir recipients were matched to controls using time-dependent propensity scores. The primary outcome was time to improvement with a secondary outcome of time to death. RESULTS: Of 96 859 COVID-19 patients, 42 473 (43.9%) received at least 1 remdesivir dose. The median age of remdesivir recipients was 65 years, 23 701 (55.8%) were male, and 22 819 (53.7%) were non-White. Matches were found for 18 328 patients (43.2%). Remdesivir recipients were significantly more likely to achieve clinical improvement by 28 days (adjusted hazard ratio [aHR] 1.19, 95% confidence interval [CI], 1.16-1.22). Remdesivir patients on no oxygen (aHR 1.30, 95% CI, 1.22-1.38) or low-flow oxygen (aHR 1.23, 95% CI, 1.19-1.27) were significantly more likely to achieve clinical improvement by 28 days. There was no significant impact on the likelihood of mortality overall (aHR 1.02, 95% CI, .97-1.08). Remdesivir recipients on low-flow oxygen were significantly less likely to die than controls (aHR 0.85, 95% CI, .77-.92; 28-day mortality 8.4% [865 deaths] for remdesivir patients, 12.5% [1334 deaths] for controls). CONCLUSIONS: These results support the use of remdesivir for hospitalized COVID-19 patients on no or low-flow oxygen. Routine initiation of remdesivir in more severely ill patients is unlikely to be beneficial.
Authors: Thomas Marjot; Christiane S Eberhardt; Tobias Boettler; Luca S Belli; Marina Berenguer; Maria Buti; Rajiv Jalan; Mario U Mondelli; Richard Moreau; Daniel Shouval; Thomas Berg; Markus Cornberg Journal: J Hepatol Date: 2022-07-20 Impact factor: 30.083
Authors: Kathleen M Andersen; Corey S Joseph; Hemalkumar B Mehta; Michael B Streiff; Joshua F Betz; Robert C Bollinger; Arielle M Fisher; Amita Gupta; Charles F LeMaistre; Matthew L Robinson; Yanxun Xu; Derek K Ng; G Caleb Alexander; Brian T Garibaldi Journal: Res Pract Thromb Haemost Date: 2022-07-15
Authors: Lennard P L Gilissen; Stefan G H Heinen; Lotte Rijpma-Jacobs; Erik Schoon; Ramon-Michel Schreuder; Anne-Marie Wensing; Mirjam C M van der Ende-van Loon; Johanne G Bloemen; Janneke M Stapelbroek; Arnold Stronkhorst Journal: Clin Exp Med Date: 2021-09-20 Impact factor: 5.057
Authors: Bogusz Jan Aksak-Wąs; Daniel Chober; Karol Serwin; Kaja Scheibe; Jolanta Niścigorska-Olsen; Anna Niedźwiedź; Monika Dobrowolska; Katarzyna Żybul; Marta Kubacka; Agnieszka Zimoń; Ewa Hołda; Joanna Mieżyńska-Kurtycz; Marta Gryczman; Grzegorz Jamro; Paweł Szakoła; Miłosz Parczewski Journal: J Inflamm Res Date: 2022-08-25