Clinical improvement, outcomes, antiviral activity, and costs associated with early treatment with remdesivir for patients with COVID-19

Wong, Carlos K H; Lau, Kristy T K; Au, Ivan C H; Xiong, Xi; Lau, Eric H Y; Cowling, Benjamin J

BACKGROUND: Evidence remains inconclusive on any significant benefits of remdesivir in mild-to-moderate COVID-19 patients. This study explored the disease progression, various clinical outcomes, changes in viral load, and costs associated with early remdesivir treatment among COVID-19 patients. METHODS: A territory-wide retrospective cohort of 10,419 patients with COVID-19 hospitalized from 21st January 2020 to 31st January 2021 in Hong Kong were identified. Early remdesivir users were matched with controls using propensity-score matching in a ratio of up to 1:4. Study outcomes were time to clinical improvement on the WHO clinical progression scale of at least 1 score; hospital discharge; recovery; viral clearance; low viral load; positive IgG antibody; in-hospital death; and composite outcomes of in-hospital death, requiring invasive ventilation or intensive care. RESULTS: After multiple imputation and propensity-score matching, the median follow-up was 14 days for both remdesivir (n=352) and control (n=1,347) groups. Time to clinical improvement was significantly shorter in the remdesivir group than that of control (hazard ratio (HR)=1.14, 95%CI 1.01-1.29, p=0.038), as well as for achieving low viral load (HR=1.51, 95%CI 1.24-1.83, p<0.001) and positive IgG antibody (HR=1.50, 95%CI 1.31-1.70, p<0.001). Early remdesivir treatment was associated with a lower risk of in-hospital death (HR=0.58, 95%CI 0.34-0.99, p=0.045), in addition to a significantly shorter length of hospital stay (difference -2.56 days, 95%CI -4.86 to -0.26, p=0.029), without increasing the risks of composite outcomes for clinical deterioration. CONCLUSIONS: Early remdesivir treatment could be extended to hospitalized patients presenting with moderate COVID-19 and not requiring oxygen therapy on admission.