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Observational Study
. 2020 Nov 1;75(11):3359-3365.
doi: 10.1093/jac/dkaa321.

Effectiveness of remdesivir in patients with COVID-19 under mechanical ventilation in an Italian ICU

Zeno Pasquini  1   2 , Roberto Montalti  3 , Chiara Temperoni  1 , Benedetta Canovari  1 , Mauro Mancini  4 , Michele Tempesta  5 , Daniela Pimpini  5 , Nicoletta Zallocco  4 , Francesco Barchiesi  1   2
Affiliations
Observational Study

Effectiveness of remdesivir in patients with COVID-19 under mechanical ventilation in an Italian ICU

Zeno Pasquini et al. J Antimicrob Chemother. .

Abstract

Background: Remdesivir is a prodrug with in vitro activity against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Its clinical efficacy in patients with COVID-19 under mechanical ventilation remains to be evaluated.

Methods: This study includes patients under mechanical ventilation with confirmed SARS-CoV-2 infection admitted to the ICU of Pesaro hospital between 29 February and 20 March 2020. During this period, remdesivir was provided on a compassionate use basis. Clinical characteristics and outcome of patients treated with remdesivir were collected retrospectively and compared with those of patients hospitalized in the same time period.

Results: A total of 51 patients were considered, of which 25 were treated with remdesivir. The median (IQR) age was 67 (59-75.5) years, 92% were men and symptom onset was 10 (8-12) days before admission to ICU. At baseline, there was no significant difference in demographic characteristics, comorbidities and laboratory values between patients treated and not treated with remdesivir. Median follow-up was 52 (46-57) days. Kaplan-Meier curves showed significantly lower mortality among patients who had been treated with remdesivir (56% versus 92%, P < 0.001). Cox regression analysis showed that the Charlson Comorbidity Index was the only factor that had a significant association with higher mortality (OR 1.184; 95% CI 1.027-1.365; P = 0.020), while the use of remdesivir was associated with better survival (OR 3.506; 95% CI 1.768-6.954; P < 0.001).

Conclusions: In this study the mortality rate of patients with COVID-19 under mechanical ventilation is confirmed to be high. The use of remdesivir was associated with a significant beneficial effect on survival.

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Figures

Figure 1.
Figure 1.
Trend of ICU admissions during the first weeks of the SARS-CoV-2 epidemic in Pesaro. During this period, four new temporary ICUs were opened, increasing the number of beds from 9 to 40. Patients included in this study were admitted to the ICU between 29 February and 20 March 2020, when access to compassionate use of remdesivir was available. This figure appears in colour in the online version of JAC and in black and white in the print version of JAC.
Figure 2.
Figure 2.
Survival analysis with Kaplan–Meier curves. Comparison between patients treated and not treated with remdesivir with a median (IQR) follow-up of 52 (46–56.5) days from admission to the ICU. This figure appears in colour in the online version of JAC and in black and white in the print version of JAC.
See this image and copyright information in PMC

Comment in

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