Early remdesivir treatment lowers risk of COVID-19 progression

In the treatment of patients with COVID-19, administering remdesivir within 5 days of symptom onset appears to reduce the risk of progression to severe disease, as shown in a study.

Compared with late treatment (>5 days from onset of symptoms), early treatment led to a significantly lower rate of a composite outcome of high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), invasive mechanical ventilation (MV), or death (32.2 percent vs 46.8 percent; p=0.018). [Clin Ther 2022;doi:10.1016/j.clinthera.2022.01.007]

Progression to severe COVID-19 was more likely to occur among patients with a history of dyspnoea at home (odds ratio [OR], 2.53, 95 percent confidence interval [CI], 1.55–4.12; p<0.001). However, this was countered by early treatment with remdesivir (OR, 0.49, 95 percent CI, 0.27–0.87; p=0.015).

Accordingly, delayed hospitalization was associated with late administration of remdesivir and, ultimately, to an increased probability of disease progression.

“Our study suggests two important observations,” according to the investigators. “First, the identification of COVID-19 patients who can benefit from an early admission to the hospital has a pivotal importance and, second, a delayed decision to hospitalize patients at high risk of progression might preclude them from the opportunity to receive potentially life-saving treatments.”

A total of 312 consecutive patients (median age 69 years, 63.1 percent male) with COVID-19 pneumonia who received remdesivir were included in the study; 90 (28.8 percent) patients received early treatment with remdesivir, while 222 (71.2 percent) late treatment.

Patients admitted within the first 5 days from onset of symptoms were older, more likely to be a resident of a long-term care facility, and more frequently had comorbid heart disease compared with those who were admitted later.

The above findings highlight that physicians do consider the importance of factors such as age, comorbidities, and frailty when treating patients with COVID-19, the investigators said. “However, other factors, such as the presence of fever and cough at home and an inflammatory status, were underestimated and associated with a delayed decision to hospitalize the patients.”

Real-life data seem to support the current observation, according to the investigators, with the study being in line with a recent work that evaluated the impact of remdesivir according to the preadmission symptom duration in patients with COVID-19. In the latter, patients admitted within ≤3 days and 4–6 days of symptom onset had a 2.5- and 1.5-fold higher risk of death, respectively. Moreover, remdesivir conferred a 62-percent reduction in the risk of death compared with standard of care—a benefit that was observed in patients who were admitted within the first 6 days but not in those admitted later. [J Antimicrob Chemother 2021;76:3296-3302]

Taken together, the data indicate that “the identification of patients who need early hospitalization, the decision of the most appropriate setting of care, and the early start of the remdesivir during the first phase of infection may provide clinical benefit in patients with COVID-19,” the investigators said.