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. 2021 Nov 12;76(12):3296-3302.
doi: 10.1093/jac/dkab321.

Impact of remdesivir according to the pre-admission symptom duration in patients with COVID-19

Carolina Garcia-Vidal  1 , Rodrigo Alonso  1 , Ana M Camon  1 , Celia Cardozo  1 , Laia Albiach  1 , Daiana Agüero  1 , M Angeles Marcos  2   3 , Juan Ambrosioni  1 , Marta Bodro  1 , Mariana Chumbita  1 , Lorena de la Mora  1 , Nicole Garcia-Pouton  1 , Gerard Dueñas  1 , Marta Hernandez-Meneses  1 , Alexy Inciarte  1 , Genoveva Cuesta  2   3 , Fernanda Meira  1 , Laura Morata  1 , Pedro Puerta-Alcalde  1 , Sabina Herrera  1 , Montse Tuset  4 , Pedro Castro  5 , Sergio Prieto-Gonzalez  6 , Alex Almuedo-Riera  3   7 , Josep Mensa  1 , José Antonio Martínez  1 , Gemma Sanjuan  1   8 , J M Nicolas  5 , A Del Rio  1 , José Muñoz  3   7 , Jordi Vila  2   3 , Felipe Garcia  1 , Alex Soriano  1 ; Hospital Clinic of Barcelona COVID-19 Research Group
Collaborators, Affiliations

Impact of remdesivir according to the pre-admission symptom duration in patients with COVID-19

Carolina Garcia-Vidal et al. J Antimicrob Chemother. .

Abstract

Background: The use of remdesivir has demonstrated a significant reduction in the time to recovery in patients with COVID-19. However, the impact on mortality is still controversial. Therefore, it is necessary to evaluate whether there is a specific subgroup of patients in whom an active antiviral therapy also reduces the mortality.

Methods: Patients admitted for >48 h in our hospital for a SARS-CoV-2 confirmed or suspected infection from February 2020 to February 2021 were retrospectively analysed. The primary outcome of the study was mortality at 30 days. Univariate and multivariate analyses were performed to identify predictors of mortality.

Results: In total, 2607 patients (438 receiving remdesivir and 2169 not) were included with a median (IQR) age of 65 (54-77) years and 58% were male. Four hundred and seventy-six were admitted to the ICU (18.3%) and 264 required invasive mechanical ventilation (10.1%). The global 30 day mortality rate was 10.7%. Pre-admission symptom duration of 4-6 days and ≤3 days was associated with a 1.5- and 2.5-fold increase in the mortality rate, respectively, in comparison with >6 days and treatment with remdesivir was independently associated with a lower mortality rate (OR = 0.382, 95% CI = 0.218-0.671). The analysis showed that the major difference was among patients with shorter pre-admission symptom duration (<6 days).

Conclusions: Patients with ≤3 days and 4-6 days from symptom onset to admission are associated with a 2.5- and 1.5-fold higher risk of death, respectively. Remdesivir was associated with 62% reduced odds of death versus standard-of-care and its survival benefit increased with shorter duration of symptoms.

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Figures

Figure 1.
Figure 1.
Flowchart of the population selected for the analysis.
Figure 2.
Figure 2.
Mortality rate at 30 days by remdesivir treatment and the pre-test duration of symptoms (proportion comparisons using χ2 test).
Figure 3.
Figure 3.
One minus the cumulative probability of survival by remdesivir treatment. (a) Patients with pre-admission duration of symptoms ≤3 days. (b) Patients with pre-admission duration of symptoms of 4–6 days. (c) Patients with pre-admission duration of symptoms >6 days. (d) The entire population included in the study. Remdesivir treatment corresponds to 1 (continuous line) and no remdesivir corresponds to 0 (broken line).
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