Remdesivir may improve outcomes tied to long COVID

Remdesivir may cut the risk of symptoms and diagnoses associated with possible post-COVID conditions (PCC), otherwise known as long COVID.

“[Age] is a predictor of general outcomes in patients hospitalized with COVID-19,” said the researchers. “[Our findings demonstrated that] remdesivir treatment was associated with a reduced risk of symptoms and diagnoses related to possible PCC after COVID-19 hospitalization in patients aged <65 and ≥65 years.”

Compared with patients who were not treated with remdesivir during the first 2 days of hospitalization, those who received the study drug had a lower relative hazards for any symptom and diagnosis tied to PCC (hazard ratio [HR], 0.90, 95 percent confidence interval [CI], 0.86–0.93 [<65 years] and HR, 0.90, 95 percent CI, 0.86–0.95 [≥65 years]). [CROI 2024, abstract 657]

Remdesivir was also associated with a lower risk for half of the 16 individual possible PCC-related symptoms/diagnoses in the younger subgroup (HRs ranging between 0.38 and 0.88). In the older subgroup, the risk was lower for six individual symptoms/diagnoses (HRs ranging between 0.08 and 0.89). According to the researchers, these findings suggest that more PCC-related symptoms/diagnoses were influenced by remdesivir, with stronger effect sizes in the younger cohort.

Symptoms may last for years

Long COVID is heterogenous, encompassing a broad range of respiratory, cardiovascular, neurologic, digestive, and other general symptoms that could persist even for years following the index SARS-CoV-2 infection. [https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html; MMWR Morb Mortal Wkly Rep 2023;72:866-870; EClinicalMedicine 2022;55:101762]

The investigators retrospectively evaluated data from the HealthVerity database to determine the effect of remdesivir during acute COVID-19 illness on the incidence of PCC-related symptoms/diagnoses in hospitalized COVID-19 patients in the US. A total of 52,006 patients were eligible to participate. More than half of the participants were <65 years (n=33,578; mean age 49 years, 52 percent men).

On day 1 or 2 of hospitalization, nearly half of the overall cohort were admitted to the intensive care unit, and 94 percent of remdesivir-treated participants received corticosteroids.

The fraction of participants who received remdesivir in the <65- and ≥65-year subgroups were 36 percent and 27 percent, respectively.

Of note was the high proportion of participants in both groups who did not receive remdesivir, the researchers pointed out. “[This indicates] a missed opportunity for treatment of acute COVID-19 and potential prevention of long-term sequelae of infection.”

The 16 PCC-associated symptoms/diagnoses occurring 90–270 days following hospitalization included cough, dyspnoea/breathlessness, chest pain, ischaemic heart disease, thromboembolic disease, cerebrovascular disease, cognitive dysfunction, dysautonomia, headache, neuropsychiatric features, diarrhoea, taste disturbance/dysgeusia/ageusia, smell disturbance/anosmia, fatigue, joint pain/arthralgia, and muscle pain/myalgia.

Neuropsychiatric features were the most common PCC-related symptom/diagnosis in both younger and older age groups (rate per 100 person-years, 58.0 and 52.3, respectively); the least frequent were taste disturbance/dysgeusia/ageusia and dysautonomia (rate per 100 person-years, 0.1 for both) for both age groups.

Limitations

One of the limitations underlined by the investigators was the use of hospital chargemaster and medical claims data. “Therefore, [the findings] may only be generalizable to patients who are insured and who seek medical care.”

Moreover, the PCC-related symptoms/diagnoses evaluated are nonspecific to PCC and may be attributable to other diseases. It is also possible that these conditions were already present at baseline.

“[Nonetheless], we expect nondifferential misclassification between remdesivir-treated and untreated groups, and sensitivity analyses excluding patients with PCC symptoms/diagnoses at baseline found similar associations,” the investigators noted.

Sensitivity analysis also revealed a lower risk for ischaemic heart disease and fatigue in the younger subgroup.