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Observational Study
. 2022 Dec;134(23-24):883-891.
doi: 10.1007/s00508-022-02098-9. Epub 2022 Oct 27.

Early administration of remdesivir may reduce mortality in hospitalized COVID-19 patients : A propensity score matched analysis

Mario Karolyi  1 , Lukas Kaltenegger  2 , Erich Pawelka  3 , Avelino Kuran  3 , Moritz Platzer  3 , David Totschnig  3 , Franz Koenig  2 , Wolfgang Hoepler  3 , Hermann Laferl  3 , Sara Omid  3 , Tamara Seitz  3 , Marianna Traugott  3 , Sigrun Arthofer  4 , Lea Erlbeck  4 , Stefan Jaeger  4 , Alina Kettenbach  4 , Alice Assinger  5 , Christoph Wenisch  3 , Alexander Zoufaly  3   4
Affiliations
Observational Study

Early administration of remdesivir may reduce mortality in hospitalized COVID-19 patients : A propensity score matched analysis

Mario Karolyi et al. Wien Klin Wochenschr. 2022 Dec.

Abstract

Background: Remdesivir is the only antiviral agent approved for the treatment of hospitalized coronavirus disease 2019 (COVID-19) patients requiring supplemental oxygen. Studies show conflicting results regarding its effect on mortality.

Methods: In this single center observational study, we included adult hospitalized COVID-19 patients. Patients who were treated with remdesivir were compared to controls. Remdesivir was administered for 5 days. To adjust for any imbalances in our cohort, a propensity score matched analysis was performed. The aim of our study was to analyze the effect of remdesivir on in-hospital mortality and length of stay (LOS).

Results: After propensity score matching, 350 patients (175 remdesivir, 175 controls) were included in our analysis. Overall, in-hospital mortality was not significantly different between groups remdesivir 5.7% [10/175] vs. control 8.6% [15/175], hazard ratio 0.50, 95% confidence interval (CI) 0.22-1.12, p = 0.091. Subgroup analysis showed a significant reduction of in-hospital mortality in patients who were treated with remdesivir ≤ 7 days of symptom onset remdesivir 4.2% [5/121] vs. control 10.4% [13/125], hazard ratio 0.26, 95% CI 0.09 to 0.75, p = 0.012 and in female patients remdesivir 2.9% [2/69] vs. control 12.2% [9/74], hazard ratio 0.18 95%CI 0.04 to 0.85, p = 0.03. Patients in the remdesivir group had a significantly longer LOS (11 days vs. 9 days, p = 0.046).

Conclusion: Remdesivir did not reduce in-hospital mortality in our whole propensity score matched cohort, but subgroup analysis showed a significant mortality reduction in female patients and in patients treated within ≤ 7 days of symptom onset. Remdesivir may reduce mortality in patients who are treated in the early stages of illness.

Keywords: Austria; Gender differences; In-hospital mortality; Length of stay; Within 7 days.

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Conflict of interest statement

M. Karolyi, L. Kaltenegger, E. Pawelka, A. Kuran, M. Platzer, D. Totschnig, F. Koenig, W. Hoepler, H. Laferl, S. Omid, T. Seitz, M. Traugott, S. Arthofer, L. Erlbeck, S. Jaeger, A. Kettenbach, A. Assinger, C. Wenisch and A. Zoufaly declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan-Meier plot—In-hospital mortality—propensity score matched cohort. The following variables were used to calculate the propensity score: gender, age, duration of symptoms before admission (measured in days), number of comorbidities, respiratory insufficiency on admission (dichotomous), C‑reactive protein. RDV remdesivir
Fig. 2
Fig. 2
Kaplan-Meier plot—Length of stay—propensity score matched cohort. The following variables were used to calculate the propensity score: gender, age, duration of symptoms before admission (measured in days), number of comorbidities, respiratory insufficiency on admission (dichotomous), C‑reactive protein. RDV remdesivir
Fig. 3
Fig. 3
Subgroup analysis—In-hospital mortality—propensity score matched cohort. The following variables were used to calculate the propensity score: gender, age, duration of symptoms before admission (measured in days), number of comorbidities, respiratory insufficiency on admission (dichotomous), C‑reactive-protein. RDV remdesivir, HR hazard ratio
See this image and copyright information in PMC

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