Corticosteroid-remdesivir combo safely suppresses secondary infections in severe COVID-19

The combination of corticosteroid (CS) therapy with remdesivir (RDV) has noninferior survival outcomes relative to CS monotherapy in patients hospitalized with the coronavirus disease 2019 (COVID-19), reports a recent study.

Moreover, the combination therapy significantly reduces secondary bacterial infections (SBI) in severely ill COVID-19 patients.

The observational cohort study included 388 COVID-19 patients (aged 18–90 years) who required ventilatory support. Most (76.5 percent; n=297) were treated with CS alone, while 91 (23.5 percent) received concomitant RDV. Both patient groups received at least 48 hours of therapy.

After propensity score matching, the primary outcome of 28-day all-cause mortality rate was statistically comparable between the CS-RDV and CS monotherapy groups (36.5 percent vs 29.7 percent, respectively; p=0.38). Length of stay was likewise similar between groups (p=1.00).

On the other hand, SBI occurred at a significantly greater frequency in patients treated with CS alone vs CS-RDV (35.1 percent vs 13.5 percent; p=0.02). Infection rates of methicillin-resistant Staphylococcus aureus or Pseudomonas were comparable between arms (p=1.00).

Log-rank analysis confirmed that SBI incidence was indeed statistically higher in the CS monotherapy group at 28 days (94.5 percent vs 59.9 percent; p<0.01) but did not appear to be an independent correlate of mortality (37.5 percent vs 85.7 percent; p=0.10).

“It is unconfirmed whether the current evidence on lack of recovery and mortality benefit in ventilated patients with RDV can be improved with concomitant CS use. There are theoretical reasons that combination therapy may be beneficial in some patients with severe COVID-19,” the researchers said.

“However, the safety and efficacy have not been rigorously studied in clinical trials, especially in ventilated patients,” they added.

While the current study improves understanding of this novel treatment regime, further research is needed to validate the present findings, they noted.