Remdesivir Versus Standard-of-Care for Severe Coronavirus Disease 2019 Infection: An Analysis of 28-Day Mortality

Susan A. Olender, Theresa L. Walunas, Esteban Martinez, Katherine K. Perez, Antonella Castagna, Su Wang, Dax Kurbegov, Parag Goyal, Diego Ripamonti, Bindu Balani, Francesco G. De Rosa, Stéphane De Wit, Shin Woo Kim, George Diaz, Raffaele Bruno, Kathleen M. Mullane, David Chien Lye, Robert L. Gottlieb, Richard H. Haubrich, Anand P. ChokkalingamGeorge Wu, Helena Diaz-Cuervo, Diana M. Brainard, I. Heng Lee, Hao Hu, Lanjia Lin, Anu O. Osinusi, Jose I. Bernardino, Marta Boffito

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Remdesivir is approved by the US Food and Drug Administration for the treatment of patients hospitalized with coronavirus disease 2019 (COVID-19) and has been shown to shorten time to recovery and improve clinical outcomes in randomized trials. Methods: This was the final day 28 comparative analysis of data from a phase 3, randomized, open-label study comparing 2 remdesivir regimens (5 vs 10 days, combined for this analysis [remdesivir cohort]) and a real-world retrospective longitudinal cohort study of patients receiving standard-of-care treatment (nonremdesivir cohort). Eligible patients, aged ≥18 years, had confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), oxygen saturation ≤94% on room air or required supplemental oxygen, with pulmonary infiltrates. Propensity score matching (up to 1:10 ratio) was used to ensure comparable populations. We assessed day 14 clinical recovery (determined using a 7-point ordinal scale) and day 28 all-cause mortality (coprimary endpoints). Results: A total of 368 (remdesivir) and 1399 (nonremdesivir) patients were included in the matched analysis. The day 14 clinical recovery rate was significantly higher among the remdesivir versus the nonremdesivir cohort (65.2% vs 57.1%; odds ratio [OR], 1.49; 95% confidence interval [CI], 1.16-1.90; P=0.002). The day 28 mortality rate was significantly lower in the remdesivir cohort versus the nonremdesivir cohort (12.0% vs 16.2%; OR, 0.67; 95% CI, 0.47-.95; P=.03). Conclusions: Remdesivir was associated with significantly higher rates of day 14 clinical recovery, and lower day 28 mortality, compared with standard-of-care treatment in hospitalized patients with COVID-19. These data, taken together, support the use of remdesivir to improve clinical recovery and decrease mortality from SARS-CoV-2 infection.

Original languageEnglish
Article numberofab278
JournalOpen Forum Infectious Diseases
Volume8
Issue number7
DOIs
Publication statusPublished - Jul 2021

Keywords

  • COVID-19
  • mortality
  • remdesivir
  • SARS-CoV-2

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

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