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. 2023 Oct;12(10):2471-2484.
doi: 10.1007/s40121-023-00874-2. Epub 2023 Oct 6.

Rapid Response to Remdesivir in Hospitalised COVID-19 Patients: A Propensity Score Weighted Multicentre Cohort Study

Emiel Leegwater  1   2   3 , Lisa Dol  4   5   6 , Menno R Benard  7 , Eveline E Roelofsen  8 , Nathalie M Delfos  9 , Machteld van der Feltz  9 , Femke P N Mollema  10 , Liesbeth B E Bosma  11 , Loes E Visser  11   12 , Thomas H Ottens  13 , Nathalie D van Burgel  14 , Sesmu M Arbous  6 , Lahssan H El Bouazzaoui  15 , Rachel Knevel  16 , Rolf H H Groenwold  17 , Mark G J de Boer  4 , Leo G Visser  4 , Frits R Rosendaal  17 , Erik B Wilms  11   18 , Cees van Nieuwkoop  5   19
Affiliations

Rapid Response to Remdesivir in Hospitalised COVID-19 Patients: A Propensity Score Weighted Multicentre Cohort Study

Emiel Leegwater et al. Infect Dis Ther. 2023 Oct.

Abstract

Introduction: Remdesivir is a registered treatment for hospitalised patients with COVID-19 that has moderate clinical effectiveness. Anecdotally, some patients' respiratory insufficiency seemed to recover particularly rapidly after initiation of remdesivir. In this study, we investigated if this rapid improvement was caused by remdesivir, and which patient characteristics might predict a rapid clinical improvement in response to remdesivir.

Methods: This was a multicentre observational cohort study of hospitalised patients with COVID-19 who required supplemental oxygen and were treated with dexamethasone. Rapid clinical improvement in response to treatment was defined by a reduction of at least 1 L of supplemental oxygen per minute or discharge from the hospital within 72 h after admission. Inverse probability of treatment-weighted logistic regression modelling was used to assess the association between remdesivir and rapid clinical improvement. Secondary endpoints included in-hospital mortality, ICU admission rate and hospitalisation duration.

Results: Of 871 patients included, 445 were treated with remdesivir. There was no influence of remdesivir on the occurrence of rapid clinical improvement (62% vs 61% OR 1.05, 95% CI 0.79-1.40; p = 0.76). The in-hospital mortality was lower (14.7% vs 19.8% OR 0.70, 95% CI 0.48-1.02; p = 0.06) for the remdesivir-treated patients. Rapid clinical improvement occurred more often in patients with low C-reactive protein (≤ 75 mg/L) and short duration of symptoms prior to hospitalisation (< 7 days) (OR 2.84, 95% CI 1.07-7.56).

Conclusion: Remdesivir generally does not increase the incidence of rapid clinical improvement in hospitalised patients with COVID-19, but it might have an effect in patients with short duration of symptoms and limited signs of systemic inflammation.

Keywords: COVID-19; Hospitalized patients; Rapid clinical improvement; Remdesivir.

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Conflict of interest statement

Emiel Leegwater and Erik B Wilms of The Hague Hospital Pharmacy received an unrestricted research grant from Gilead Sciences Inc. T.H.O. participated in a COVID-19 Digital Advisory Board from Gilead Sciences Inc. Lisa Dol, Menno R Benard, Eveline E Roelofsen, Nathalie M Delfos, Machteld van der Feltz, Femke PN Mollema, Liesbeth BE Bosma, Loes E Visser, Thomas H Ottens, Nathalie D van Burgel, Sesmu M Arbous, Lahssan H El Bouazzaoui, Rachel Knevel, Rolf HH Groenwold, Mark GJ de Boer, Leo G Visser, Frits R Rosendaal, and Cees van Nieuwkoop have nothing to disclose.

Figures

Fig. 1
Fig. 1
Flowchart of patients included in this study
Fig. 2
Fig. 2
Effect of remdesivir on rapid clinical improvement in patient subgroups. For each subgroup the OR (dots) and 95% CI (lines) are shown
See this image and copyright information in PMC

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