More evidence for remdesivir in severe COVID-19

Treatment with remdesivir reduced mortality in a large cohort of hospitalized patients requiring high-flow oxygen, according to a study presented at ECCMID 2023.

The reduction in mortality was consistent across all waves of the pandemic.

“Our analysis suggests there is a role for remdesivir in severe COVID-19 infection requiring high-flow oxygen or noninvasive ventilation [HFO/NIV],” said study author Dr Ezzy Mozaffari from Gilead Sciences, Foster City, California, US.

Remdesivir has been studied in randomized controlled trials and real-world observational studies across oxygenation levels in patients hospitalized for COVID-19. “We extended previous analyses of remdesivir, focusing this time on hospitalized patients on high-flow oxygen/noninvasive ventilation registered in the US Premier Healthcare Database,” said Mozzafari. “We sought to compare hospital all-cause mortality in those treated with remdesivir vs those who were not.”

Wider coverage, longer VoC period

The study spanned across three variants of concern (VoC) periods – pre-Delta from December 2020 to April 2021; Delta-predominant from May to November 2021; and Omicron-predominant from December 2021 to April 2022. [ECCMID 2023, abstract O1120]

Included were 34,857 adults with a primary diagnosis of COVID-19 receiving HFO/NIV in the first two days of hospitalization. Patients were excluded if discharged within three days of remdesivir initiation. Mortality at 14 and 28 days was examined.

Mortality outcomes

During pre-Delta period, patients on HFO/NIV receiving remdesivir had significantly lower mortality rates at 14 and 28 days (17.9 percent and 26.8 percent) compared with patients not receiving remdesivir (20.4 percent and 29.5 percent). After adjusting for baseline and clinical covariates, the risk of death at 14 days in remdesivir-treated patients was 14 percent lower and 12-percent lower at 28 days (p<0.0001 for both) vs non-remdesivir-treated patients.

Similarly, those on HFO/NIV receiving remdesivir had significantly lower mortality rates at 14 and 28 days (15.9 percent and 25.5 percent) vs patients not on remdesivir (18.4 percent and 27.1 percent) during the Delta-dominant period. After adjustment, the risk of death at 14 days was 18 percent lower in patients treated with remdesivir and 11 percent lower at 28 days (p<0.0001 for both).

The same was true during the Omicron-dominant period. Patients on HFO/NIV receiving remdesivir had significantly lower mortality rates at both 14 and 28 days (16.8 percent and 25 percent) vs patients not receiving remdesivir (20 percent and 28.5 percent). Their risk of death was 20 percent lower at 14 days and 16 percent lower at 28 days vs non-remdesivir-treated patients. 

“Remdesivir given in the first two days of hospitalization results in a significant reduction in mortality across all waves of the pandemic in a real-world setting,” said Mossafari. “Again, this analysis appropriately positions remdesivir for severe COVID-19 infection requiring HFO/NIV.”