Remdesivir for the Prevention of Invasive Mechanical Ventilation or Death in Coronavirus Disease 2019 (COVID-19): A Post Hoc Analysis of the Adaptive COVID-19 Treatment Trial-1 Cohort Data

Abstract

This post hoc analysis of the Adaptive Coronavirus Disease 2019 (COVID-19) Treatment Trial-1 (ACTT-1) shows a treatment effect of remdesivir (RDV) on progression to invasive mechanical ventilation (IMV) or death. Additionally, we create a risk profile that better predicts progression than baseline oxygen requirement alone. The highest risk group derives the greatest treatment effect from RDV.

Keywords: ACTT-1; COVID-19; remdesivir.

Figure 1.

Kaplan-Meier estimates of remdesivir (RDV) treatment effect for progression to invasive mechanical ventilation (IMV) or death: Probability of progression to IMV or death is shown in panel A for subjects receiving RDV (blue) and placebo (red) in risk profile quartiles defined by baseline oxygen requirement, ALC, ANC, and platelets. Quartiles from top to bottom are “high risk,” “moderate risk,” “lower risk,” and “least risk.” Probability of progression to IMV or death is shown in panel B for subjects receiving RDV (blue) and placebo (red) in each ACTT-1 ordinal score (OS group). Ordinal scores from top to bottom are OS7 (requiring IMV or extracorporeal membrane oxygenation [ECMO]). OS6 (requiring noninvasive positive pressure ventilation (NIPPV) or high-flow oxygen [HFO]), OS5 (requiring supplemental oxygen) and OS4 (not requiring supplemental oxygen). Probability of progression to IMV or death is shown in panel C for subjects receiving RDV (blue) and placebo (red) in the overall ACTT-1 data set. HR estimates with a value <1 indicate that treatment effect is associated with being less likely to progress to IMV or death. Number-at-risk table is provided for each plot with numbers colored by treatment group. Abbreviations: ACTT-1, Adaptive COVID-19 Treatment Trial-1; ALC, absolute lymphocyte count; ANC, absolute neutrophil count; CI, confidence interval; HR. hazard ratio.