Effectiveness of remdesivir with corticosteroids for COVID‐19 patients in intensive care unit: A hospital‐based observational study

Abstract

The effectiveness of remdesivir on survival in coronavirus disease 2019 (COVID‐19), especially in cases treated in the intensive care unit (ICU), is controversial. We investigated the effectiveness of remdesivir with corticosteroids on the survival of COVID‐19 patients in a real ICU clinical practice. For laboratory‐confirmed COVID‐19 patients admitted to the ICU of a tertiary hospital in Tokyo (April 2020–November 2021) and who received corticosteroids, the effectiveness of remdesivir for survival, stratified by interval length (within 9 or 10+ days), was retrospectively analyzed using Cox regression model. A total of 168 patients were included: 35 with no remdesivir use (control), 96 with remdesivir use within 9 days, and 37 with remdesivir use with an interval of 10+ days. In‐hospital mortality was 45.7%, 10.4%, and 16.2%, respectively. After adjusting for possible covariates including comorbidities, laboratory data, oxygen demand, or level of pneumonia, remdesivir use within 9 days from symptom onset reduced mortality risk (hazard ratio [HR]: 0.10; 95% confidence interval (CI): 0.025–0.428) compared to the control group. However, remdesivir use with an interval of 10+ days showed no significant association with mortality (HR: 0.42; 95% CI: 0.117–1.524). Among COVID‐19 patients who received corticosteroids in ICU, remdesivir use within 9 days from symptom onset was associated with reduced in‐hospital mortality risk.

Evaluation of Remdesivir Utilization Pattern in Critically Ill Patients With COVID-19 in Jazan Province

“…Our study reported a significant decrease (p<0.001) in blood hemoglobin (Hb) levels in 55.7% of patients, which is similar to other findings in the literature [ 56 , 57 ]. The use of remdesivir is associated with a 2.8-fold risk of AKI [ 58 ].…”

“…Hospitalized COVID-19 patients requiring intensive care may develop hyperglycemia (an increase in blood glucose {BG}), mainly due to increased glucose production, virus-induced immune response, and insulin resistance [44]. Our study reported a significant decrease (p<0.001) in blood hemoglobin (Hb) levels in 55.7% of patients, which is similar to other findings in the literature [56,57]. The use of remdesivir is associated with a 2.8-fold risk of AKI [58].…”

Use of Remdesivir in Patients with SARS-CoV-2 Pneumonia in a Real-Life Setting during the Second and Third COVID-19 Epidemic Waves

“…These findings are also consistent with studies that demonstrated the efficacy of RDSV use within nine days from symptom onset in reducing in-hospital mortality, probably due to the kinetics of the viral load of SARS-CoV-2 in the respiratory tract [30].…”

“…Exploring the risk factors related to the endpoints of interest in our population, we found that classical factors such as higher age and the presence of comorbidities were associated with mortality or the risk to develop severe ARDS, while factors such as female sex and higher PaO2/FiO2 at admission resulted to be protective, in accordance with other studies [29][30][31]. These data confirm that the elderly and patients with comorbidities represent a vulnerable population to the worse outcome of COVID-19 and that the mortality of RDSV-treated patients is significantly related to the need for higher levels of O 2 support.…”

Innate and adaptive immune response in SARS-CoV-2 infection-Current perspectives

“…A 5 day remdesivir therapy of COVID-19 patients showed greater clinical improvement than patients in placebo group, but not different from a 10 day therapy ( 149 ). For cases treated in the ICU, remdesivir use within 9 days from symptom onset reduced mortality risk compared with control group ( 150 ).…”