Vincenzo Spagnuolo1, Marta Voarino2, Marco Tonelli2,3, Laura Galli1, Andrea Poli1, Elena Bruzzesi2, Sara Racca3, Nicola Clementi2,3, Chiara Oltolini1, Moreno Tresoldi4, Patrizia Rovere Querini2,5, Lorenzo Dagna2,6, Alberto Zangrillo2,7, Fabio Ciceri2,8, Massimo Clementi2,3, Antonella Castagna1,2. 1. Unit of Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy. 2. Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy. 3. Unit of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy. 4. General Medicine and Advanced Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. 5. Internal Medicine, Diabetes, and Endocrinology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. 6. Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy. 7. Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy. 8. Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Abstract
Background: Evidence regarding the impact of remdesivir (RDV) on SARS-CoV-2 viral clearance (VC) is scarce. The aim of this study was to compare VC timing in hospitalized COVID-19 patients who did or did not receive RDV. Methods: This was a matched-cohort study of patients hospitalized with pneumonia, a SARS-CoV-2-positive nasopharyngeal swab (NPS) at admission, and at least one NPS during follow-up. Patients who received RDV (cases) and those who did not (controls) were matched in a 1:2 ratio by age, sex, and PaO2/FiO2 (P/F) values at admission. NPSs were analyzed using real-time polymerase chain reaction. Time to VC (within 30 days after hospital discharge) was estimated using the Kaplan-Meier curve. A multivariable Cox proportional hazard model was fitted to determine factors associated with VC. Results: There were 648 patients enrolled in the study (216 cases and 432 controls). VC was observed in 490 patients (75.6%), with a median time of 25 (IQR 16-34) days. Overall, time to VC was similar between cases and controls (p = 0.519). However, time to VC was different when considering both RDV treatment status and age (p = 0.007). A significant finding was also observed when considering both RDV treatment status and P/F values at admission (p = 0.007). A multivariate analysis showed that VC was associated with a younger age (aHR = 0.990, 95% CI 0.983-0.998 per every 10-year increase in age; p = 0.009) and a higher baseline P/F ratio (aHR=1.275, 95% CI 1.029-1.579; p=0.026), but not with RDV treatment status. Conclusion: Time to VC was similar in cases and controls. However, there was a benefit associated with using RDV in regard to time to VC in younger patients and in those with a P/F ratio ≤200 mmHg at hospital admission.
Background: Evidence regarding the impact of remdesivir (RDV) on SARS-CoV-2 viral clearance (VC) is scarce. The aim of this study was to compare VC timing in hospitalized COVID-19 patients who did or did not receive RDV. Methods: This was a matched-cohort study of patients hospitalized with pneumonia, a SARS-CoV-2-positive nasopharyngeal swab (NPS) at admission, and at least one NPS during follow-up. Patients who received RDV (cases) and those who did not (controls) were matched in a 1:2 ratio by age, sex, and PaO2/FiO2 (P/F) values at admission. NPSs were analyzed using real-time polymerase chain reaction. Time to VC (within 30 days after hospital discharge) was estimated using the Kaplan-Meier curve. A multivariable Cox proportional hazard model was fitted to determine factors associated with VC. Results: There were 648 patients enrolled in the study (216 cases and 432 controls). VC was observed in 490 patients (75.6%), with a median time of 25 (IQR 16-34) days. Overall, time to VC was similar between cases and controls (p = 0.519). However, time to VC was different when considering both RDV treatment status and age (p = 0.007). A significant finding was also observed when considering both RDV treatment status and P/F values at admission (p = 0.007). A multivariate analysis showed that VC was associated with a younger age (aHR = 0.990, 95% CI 0.983-0.998 per every 10-year increase in age; p = 0.009) and a higher baseline P/F ratio (aHR=1.275, 95% CI 1.029-1.579; p=0.026), but not with RDV treatment status. Conclusion: Time to VC was similar in cases and controls. However, there was a benefit associated with using RDV in regard to time to VC in younger patients and in those with a P/F ratio ≤200 mmHg at hospital admission.
Authors: James Regan; James P Flynn; Alexandra Rosenthal; Hannah Jordan; Yijia Li; Rida Chishti; Francoise Giguel; Heather Corry; Kendyll Coxen; Jesse Fajnzylber; Elizabeth Gillespie; Daniel R Kuritzkes; Nir Hacohen; Marcia B Goldberg; Michael R Filbin; Xu G Yu; Lindsey Baden; Ruy M Ribeiro; Alan S Perelson; Jessica M Conway; Jonathan Z Li Journal: Open Forum Infect Dis Date: 2021-04-17 Impact factor: 3.835
Authors: Timothy P Sheahan; Amy C Sims; Sarah R Leist; Alexandra Schäfer; John Won; Ariane J Brown; Stephanie A Montgomery; Alison Hogg; Darius Babusis; Michael O Clarke; Jamie E Spahn; Laura Bauer; Scott Sellers; Danielle Porter; Joy Y Feng; Tomas Cihlar; Robert Jordan; Mark R Denison; Ralph S Baric Journal: Nat Commun Date: 2020-01-10 Impact factor: 14.919
Authors: Varnica Bajaj; Nirupa Gadi; Allison P Spihlman; Samantha C Wu; Christopher H Choi; Vaishali R Moulton Journal: Front Physiol Date: 2021-01-12 Impact factor: 4.566
Authors: Hongchao Pan; Richard Peto; Ana-Maria Henao-Restrepo; Marie-Pierre Preziosi; Vasee Sathiyamoorthy; Quarraisha Abdool Karim; Marissa M Alejandria; César Hernández García; Marie-Paule Kieny; Reza Malekzadeh; Srinivas Murthy; K Srinath Reddy; Mirta Roses Periago; Pierre Abi Hanna; Florence Ader; Abdullah M Al-Bader; Almonther Alhasawi; Emma Allum; Athari Alotaibi; Carlos A Alvarez-Moreno; Sheila Appadoo; Abdullah Asiri; Pål Aukrust; Andreas Barratt-Due; Samir Bellani; Mattia Branca; Heike B C Cappel-Porter; Nery Cerrato; Ting S Chow; Najada Como; Joe Eustace; Patricia J García; Sheela Godbole; Eduardo Gotuzzo; Laimonas Griskevicius; Rasha Hamra; Mariam Hassan; Mohamed Hassany; David Hutton; Irmansyah Irmansyah; Ligita Jancoriene; Jana Kirwan; Suresh Kumar; Peter Lennon; Gustavo Lopardo; Patrick Lydon; Nicola Magrini; Teresa Maguire; Suzana Manevska; Oriol Manuel; Sibylle McGinty; Marco T Medina; María L Mesa Rubio; Maria C Miranda-Montoya; Jeremy Nel; Estevao P Nunes; Markus Perola; Antonio Portolés; Menaldi R Rasmin; Aun Raza; Helen Rees; Paula P S Reges; Chris A Rogers; Kolawole Salami; Marina I Salvadori; Narvina Sinani; Jonathan A C Sterne; Milena Stevanovikj; Evelina Tacconelli; Kari A O Tikkinen; Sven Trelle; Hala Zaid; John-Arne Røttingen; Soumya Swaminathan Journal: N Engl J Med Date: 2020-12-02 Impact factor: 91.245
Authors: Giuseppe Lapadula; Davide Paolo Bernasconi; Giacomo Bellani; Alessandro Soria; Roberto Rona; Michela Bombino; Leonello Avalli; Egle Rondelli; Barbara Cortinovis; Enrico Colombo; Maria Grazia Valsecchi; Guglielmo Marco Migliorino; Paolo Bonfanti; Giuseppe Foti Journal: Open Forum Infect Dis Date: 2020-10-13 Impact factor: 3.835