Although mortality benefit was not demonstrated, treatment with remdesivir for COVID-19 showed a more rapid clinical recovery in racially/ethnically diverse patients, according to study results published in JAMA Network Open. A combination of remdesivir and corticosteroids did not improve mortality risk and was associated with longer time to clinical improvement compared with remdesivir alone.
This retrospective, multicenter study compared data of patients with COVID-19 admitted to 1of 5 hospitals that comprise the Johns Hopkins Medicine System treated with or without remdesivir. The authors used a time-dependent propensity score matching to compare patients in the remdesivir group with patients in the control group.
The primary outcome was rate of clinical improvement, defined as hospital discharge or a 2-point drop on the World Health Organization severity score; secondary outcome was mortality at 28 days.
Of the 342 patients (mean age, 60 years; 55.3% men) who received remdesivir either alone or with corticosteroids, 285 participants who received remdesivir were matched to 285 participants in the control group. Of the 285 patients in the remdesivir group, 59 (20.7%) self-identified as non-Latinx White, 95 (33.3%) as non-Latinx Black, and 98 (34.4%) as Latinx. Most patients completed a 5-day course of remdesivir, with a median 1.1 days from admission to treatment.
Patients in the remdesivir group had a shorter median time to clinical improvement compared with patients in the control group (5 vs 7 days; adjusted hazard ratio [aHR], 1.47; 95% CI, 1.22%-1.79%). In addition, patients treated with remdesivir who were breathing ambient air or nasal cannula oxygen, as well as those with severe disease, had a shorter time to clinical improvement than controls.
Although mortality at 28 days favored remdesivir (7.7%) compared with matched controls (14.0%), the difference was not statistically significant (aHR, 0.70; 95% CI, 0.38%-1.28%) with the median time to death similar between the groups (8.6 days for remdesivir vs 8.2 days for controls).
Sensitivity analyses using the Adaptive COVID-19 Treatment Trial (ClinicalTrials.gov Identifier: NCT04280705) inclusion criteria, decreasing the number of hospitalized days from 5 to 4 days, and using a 1-point improvement in the World Health Organization severity score, yielded similar results.
The authors also compared clinical improvement and time to death in patients who received remdesivir with corticosteroids (n=184) vs patients who received remdesivir alone (n=158). Combination therapy was associated with longer time to clinical improvement (aHR, 0.77; 95% CI, 0.62%-0.97%) and did not show reduced mortality risk (aHR, 1.94; 95% CI, 0.67%-5.57%).
“The combination of remdesivir and corticosteroids was not associated with reduced mortality, suggesting that additional studies assessing patients with COVID-19 are warranted,” study authors wrote.
Disclosure: Two study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of their disclosures.
Garibaldi BT, Wang K, Robinson ML, et al. Comparison of time to clinical improvement with vs without remdesivir treatment in hospitalized patients with COVID-19. JAMA Netw Open. 2021;4(3):e213071. doi:10.1001/jamanetworkopen.2021.3071