Reduced risk of death in people with SARS-CoV-2 infection treated with remdesivir: a nested case–control study

Vito, Andrea De; Poliseno, Mariacristina; Colpani, Agnese; Zauli, Beatrice; Puci, Mariangela Valentina; Santantonio, T.; Meloni, Maria Chiara; Fois, Marco; Fanelli, Chiara; Saderi, Laura; Fois, Alessandro Giuseppe; Fiore, Vito; Sotgiu, Giovanni; Babudieri, Sergio; Caputo, Sergio Lo; Madeddu, Giordano

doi:10.1080/03007995.2022.2129801

Cited by 10 publications

(8 citation statements)

References 40 publications

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“…Concomitantly, several therapies are available for hospitalised patients with moderate or severe COVID-19 [ 17 , 18 , 19 , 20 ]. Three early SARS-CoV-2 antiviral therapies are currently available in Italy.…”

Section: Introductionmentioning

confidence: 99%

Impact of Early SARS-CoV-2 Antiviral Therapy on Disease Progression

Vito

Colpani

Saderi

et al. 2022

Viruses

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Since the start of the SARS-CoV-2 pandemic, several treatments have been proposed to prevent the progression of the disease. Currently, three antiviral (molnupiravir, nirmaltrevir/r, remdesivir) and two monoclonal antibodies (casirivimab/imdevimab and sotrovimab) are available in Italy. Therefore, we aimed to evaluate the presence of risk factors associated with disease progression. We conducted a retrospective cohort study, including all patients with a confirmed diagnosis of SARS-CoV-2 evaluated between 01/01/2022 ad 10/05/2022 by our Unit of Infectious Diseases in Sassari. We defined disease progression as the necessity of starting O2 therapy. According to AIFA (Italian Medicines Agency) indications, preventive treatment was prescribed in patients with recent symptoms onset (≤five days), no need for oxygen supplementation, and risk factors for disease progression. Subgroup differences in quantitative variables were evaluated using Student’s t-test. Pearson chi-square or Fisher’s exact tests were used to assess differences for qualitative variables. Multivariate logistic regression modelling was performed to determine factors associated with progression. A two-tailed p-value less than 0.05 was considered statistically significant. All statistical analyses were performed with STATA version 17 (StataCorp, College Station, TX, USA). We included 1145 people with SARS-CoV-2 diagnosis, of which 336 (29.3%) developed severe disease with oxygen supplementation. In multivariate logistic regression analysis, age, dementia, haematologic tumors, heart failure, dyspnoea or fever at first evaluation, having ground glass opacities or consolidation at the first CT scan, and bacteria coinfection were associated with an increased risk of disease progression. Vaccination (at least two doses) and early treatment with antiviral or monoclonal antibodies were associated with a lower risk of disease progression. In conclusion, our study showed that vaccination and early treatment with antiviral and/or monoclonal antibodies significantly reduce the risk of disease progression.

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Section: Introductionmentioning

confidence: 99%

Impact of Early SARS-CoV-2 Antiviral Therapy on Disease Progression

Vito

Colpani

Saderi

et al. 2022

Viruses

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“…In our center, tixagevimab/cilgavimab was not available during the months of our study. Several drugs for patients with severe COVID-19 can also reduce mortality [ 29 , 30 , 31 , 32 , 33 ]. As shown in Table 2 , people treated with an early antiviral treatment had a lower mortality rate than those who were not.…”

Section: Discussionmentioning

confidence: 99%

Is the 4C Score Still a Valid Item to Predict In-Hospital Mortality in People with SARS-CoV-2 Infections in the Omicron Variant Era?

Vito

Colpani

Saderi

et al. 2023

Life

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Since the start of the SARS-CoV-2 pandemic, several scores have been proposed to identify infected individuals at a higher risk of progression and death. The most famous is the 4C score. However, it was developed in early 2020. Our study aimed to evaluate the accuracy of the 4C score during the wave in which the Omicron variant was prevalent. An observational study was conducted at an Italian University Hospital between 1 January and 31 July 2022. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the ability of the 4C score to predict mortality. Overall, 1186 people were recruited, of which 160 (13.5%) died. According to the 4C score, 177 (11.6%) were classified as having a low risk of mortality, 302 (25.5%) were intermediate, 596 (50.3%) were high, and 151 (12.7%) were very high. The ROC curve of the 4C score showed an AUC (95% CI) value of 0.78 (0.74–0.82). At the criterion value of > 10, the sensitivity was 76.2% and the specificity was 62.67%. Similar to previous studies, the 4C mortality score performed well in our sample, and it is still a useful tool for clinicians to identify patients with a high risk of progression. However, clinicians must be aware that the mortality rate reported in the original studies was higher than that observed in our study.

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“…Conversely, other studies reported survival benefits in a subset of patients, including the pivotal adaptive COVID-19 Treatment Trial 1 (ACTT-1) and propensity score matching (PSM) study conducted in the United States, which demonstrated improved clinical recovery in a certain subset of patients receiving RDSV and numerically lower inpatient mortality [21][22][23][24]. Several other real-world studies showed a significant survival benefit of this antiviral for all patients [23][24][25][26][27][28].…”

Section: Discussionmentioning

confidence: 99%

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

Marocco

Borgo

Tortellini

et al. 2023

Viruses

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In this retrospective comparative study, we evaluated the effectiveness of remdesivir (RDSV) in patients with SARS-CoV-2 pneumonia. Individuals hospitalized between March 2020 and August 2022 at S.M. Goretti Hospital, Latina, with a positive test for SARS-CoV-2 and, concomitantly, pneumonia, were included. The overall survival was the primary endpoint. The composite secondary endpoint included death or progression in severe ARDS at 40 days. The study population was stratified according to treatment into two groups: the RDSV group (patients treated with RDSV-based regimens) and the no-RDSV group (patients treated with any other, not RDSV-based, regimens). Factors associated with death and progression to severe ARDS or death were assessed by multivariable analysis. A total of 1153 patients (632 belonging to the RDSV group and 521 to the no-RDSV group) were studied. The groups were comparable in terms of sex, PaO2/FiO2 at admission, and duration of symptoms before hospitalization. Further, 54 patients (8.5%) in the RDSV group and 113 (21.7%) in the no-RDSV group (p < 0.001) died. RDSV was associated with a significantly reduced hazard ratio (HR) of death (HR, 0.69 [95% CI, 0.49–0.97]; p = 0.03), compared to the no-RDSV group, as well as a significantly reduced OR of progression in severe ARDS or death (OR, 0.70 [95% CI 0.49–0.98]; p = 0.04). An overall significantly higher survival rate was observed in the RDSV group (p < 0.001, by log-rank test). These findings reinforce the survival benefit of RDSV and support its routine clinical use for the treatment of COVID-19 patients.

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Reduced risk of death in people with SARS-CoV-2 infection treated with remdesivir: a nested case–control study

Cited by 10 publications

References 40 publications

Impact of Early SARS-CoV-2 Antiviral Therapy on Disease Progression

Impact of Early SARS-CoV-2 Antiviral Therapy on Disease Progression

Is the 4C Score Still a Valid Item to Predict In-Hospital Mortality in People with SARS-CoV-2 Infections in the Omicron Variant Era?

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

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