Prognostic comparison of COVID-19 outpatients and inpatients treated with Remdesivr: A retrospective cohort study

Zamani, Shokoofeh; Alizadeh, Mohammad; Shahrestanaki, Ehsan; Nami, Sahar Mohammadpoor; Qorbani, Mostafa; Aalikhani, Maryam; Gelsefid, Saeed Hassani; Khonsari, Nami Mohammadian

doi:10.1371/journal.pone.0277413

Cited by 3 publications

(2 citation statements)

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“…Drug shortages (i.e., remdesivir) during the pandemic affected treatment options for our patients [ 41 ]. This in combination with continuous changes in national treatment protocol over the LOS may also have affected our data.…”

Section: Discussionmentioning

confidence: 99%

Different COVID-19 treatments’ impact on hospital length of stay

et al. 2023

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Importance COVID-19 has adversely affected global healthcare infrastructure since 2019. Currently, there are no large-scale published reports on the efficacy of combination therapy of dexamethasone, remdesivir, and tocilizumab on COVID-19 patients. Objectives Is the combination therapy of dexamethasone, remdesivir, and tocilizumab superior to other treatments on hospitalized COVID-19 patients? Design This is a retrospective, comparative effectiveness study. Setting Single-center study Participants/interventions We analyzed different inpatient COVID-19 treatment options available in the United States and their impact on hospital length of stay (LOS) and mortality. Hospitalized COVID-19 were categorized as “mild,” “moderate” and “severe'' based on the highest level of oxygen required; room air, nasal cannula, or high flow/PAP/intubation, respectively. Patients were treated in accordance with the availability of medications and the latest treatment guidelines. Main outcomes The endpoints of the study are hospital discharges and death during hospitalization. Results 1233 COVID-19 patients were admitted from 2020 to 2021. No treatment combinations showed a statistically significant decrease in hospital LOS in mild COVID-19 patients (p = 0.186). In moderate patients, the combination of remdesivir and dexamethasone slightly decreased LOS by 1 day (p = 0.007). In severe patients, the three-drug combination of remdesivir, dexamethasone, and tocilizumab decreased LOS by 8 days (p = 0.0034) when compared to nonviable treatments, such as hydroxychloroquine and convalescent plasma transfusion. However, it did not show any statistically significant benefit when compared to two-drug regimens (dexamethasone plus remdesivir) in severe COVID-19 (p = 0.116). No treatment arm appeared to show a statistically significant decrease in mortality for severe COVID-19 patients. Conclusions Our findings suggest that three-drug combination may decrease LOS in severe COVID-19 patients when compared to two-drug therapy. However, the trend was not supported by statistical analysis. Remdesivir may not be clinically beneficial for mild hospitalized COVID-19 patients; considering its cost, one could reserve it for moderate and severe patients. Triple drug therapies, while potentially reducing LOS for severe patients, do not affect overall mortality. Additional patient data may increase statistical power and solidify these findings.

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Section: Discussionmentioning

confidence: 99%

Different COVID-19 treatments’ impact on hospital length of stay

et al. 2023

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“…The benefits of timely treatment and studies showing similar clinical outcomes in outpatients underline the need for early COVID-19 diagnosis while expanding access to outpatient antimicrobial treatment facilities. Several studies showed that RDV infusion in the outpatient setting seems to be a safe and efficient alternative to conventional hospitalization for treating non-severe COVID-19 patients [ 100 ]. In one of the studies, only 2% reported adverse effects and only 5% required hospitalization [ 101 ].…”

Section: Expert Opinion and Future Directionsmentioning

confidence: 99%

Remdesivir Use in the Real-World Setting: An Overview of Available Evidence

Akinosoglou,

Rigopoulos,

Schinas

et al. 2023

Viruses

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In the years of Coronavirus Disease 2019 (COVID-19), various treatment options have been utilized. COVID-19 continues to circulate in the global population, and the evolution of the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has posed significant challenges to the treatment and prevention of infection. Remdesivir (RDV), an anti-viral agent with in vitro efficacy against coronaviruses, is a potent and safe treatment as suggested by a plethora of in vitro and in vivo studies and clinical trials. Emerging real-world data have confirmed its effectiveness, and there are currently datasets evaluating its efficacy and safety against SARS-CoV-2 infections in various clinical scenarios, including some that are not in the SmPC recommendations according for COVID-19 pharmacotherapy. Remdesivir increases the chance of recovery, reduces progression to severe disease, lowers mortality rates, and exhibits beneficial post-hospitalization outcomes, especially when used early in the course of the disease. Strong evidence suggests the expansion of remdesivir use in special populations (e.g., pregnancy, immunosuppression, renal impairment, transplantation, elderly and co-medicated patients) where the benefits of treatment outweigh the risk of adverse effects. In this article, we attempt to overview the available real-world data of remdesivir pharmacotherapy. With the unpredictable course of COVID-19, we need to utilize all available knowledge to bridge the gap between clinical research and clinical practice and be sufficiently prepared for the future.

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Remdesivir: A Review in COVID-19

Blair

2023

Drugs

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Remdesivir (Veklury ® ), a nucleotide analogue prodrug with broad-spectrum antiviral activity, is approved for the treatment of coronavirus disease 2019 (COVID-19), the illness caused by severe acute respiratory syndrome coronavirus 2 infection. Unlike some antivirals, remdesivir has a low potential for drug-drug interactions. In the pivotal ACTT-1 trial in hospitalized patients with COVID-19, daily intravenous infusions of remdesivir significantly reduced time to recovery relative to placebo. Subsequent trials provided additional support for the efficacy of remdesivir in hospitalized patients with moderate or severe COVID-19, with a greater benefit seen in patients with minimal oxygen requirements at baseline. Clinical trials also demonstrated the efficacy of remdesivir in other patient populations, including outpatients at high risk for progression to severe COVID-19, as well as hospitalized paediatric patients. In terms of mortality, results were equivocal. However, remdesivir appeared to have a small mortality benefit in hospitalized patients who were not already being ventilated at baseline. Remdesivir was generally well tolerated in clinical trials, but pharmacovigilance data found an increased risk of hepatic, renal and cardiovascular adverse drug reactions in the real-world setting. In conclusion, remdesivir represents a useful treatment option for patients with COVID-19, particularly those who require supplemental oxygen. Supplementary Information The online version contains supplementary material available at 10.1007/s40265-023-01926-0.

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Prognostic comparison of COVID-19 outpatients and inpatients treated with Remdesivr: A retrospective cohort study

Cited by 3 publications

References 15 publications

Different COVID-19 treatments’ impact on hospital length of stay

Different COVID-19 treatments’ impact on hospital length of stay

Remdesivir Use in the Real-World Setting: An Overview of Available Evidence

Remdesivir: A Review in COVID-19

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