Remdesivir and Mortality in Patients with COVID-19.

Diaz, George A; Christensen, Alyssa B; Pusch, Tobias; Goulet, Delaney; Chang, Shu-Ching; Grunkemeier, Gary L; McKelvey, Paul A; Robicsek, Ari; French, Tom; Parsons, Guilford T; Doherty, Glenn; Laurenson, Charles; Roper, Ryan; Hadlock, Jennifer; Cover, Cameron J; Footer, Brent; Robinson, Philip; Micikas, Mary; Marfori, Jennifer E; Cronenweth, Charlotte; Mukkamala, Yogavedya; Mackiewicz, Jamie; Rai, Ekra; Matson, Martha Dickinson; Davila, Jodie; Rueda, Justin; Tipton, Reda; Algren, Heather; Ward, Brittney C; Malkoski, Stephen; Gluckman, Tyler; Tallman, Gregory B; Arguinchona, Henry; Hammond, Terese C; Standaert, Steven; Christensen, Joshua; Echaiz, Jose F; Choi, Robert; McClung, Daniel; Pacifico, Albert; Fee, Martin; Sarafian, Farjad; Berrington, William R; Goldman, Jason D

BACKGROUND The impact of remdesivir (RDV) on COVID-19 mortality is controversial, and the mortality effect in sub-groups of baseline disease severity has been incompletely explored. The purpose of this study was to assess the association of RDV with mortality in patients with COVID-19. METHODS In this retrospective cohort study we compared persons receiving RDV to persons receiving best supportive care (BSC). Patients hospitalized between 2/28/20 - 5/28/20 with laboratory confirmed SARS-CoV-2 infection were included when they developed COVID-19 pneumonia on chest radiography, and hypoxia requiring supplemental oxygen or SpO2 ≤ 94% on room air. The primary outcome was overall survival assessed with time-dependent Cox proportional-hazards regression and multivariable adjustment, including calendar time, baseline patient characteristics, corticosteroid use and effects for hospital. RESULTS 1,138 patients were enrolled including 286 who received RDV, and 852 treated with BSC, 400 of whom received hydroxychloroquine. Corticosteroids were used in 20.4% of the cohort (12.6% in RDV and 23% in BSC). In persons receiving RDV compared to those receiving BSC the HR (95%CI) for death was 0.46 (0.31 - 0.69) in the univariate model, p<0.001 and 0.60 (0.40 - 0.90) in the risk-adjusted model, p=0.014. In the sub-group of persons with baseline use of low-flow oxygen, the HR (95%CI) for death in RDV compared to BSC was 0.63 (0.39 - 1.00), p=0.049. CONCLUSION Treatment with RDV was associated with lower mortality compared to BSC. These findings remain the same in the subgroup with baseline use of low-flow oxygen.