Remdesivir-based therapy improved recovery of patients with COVID-19 in the SARSTer multicentre, real-world study

Flisiak, R.; Zarebska-Michaluk, D.; Berkan-Kawinska, A.; Tudrujek-Zdunek, M.; Rogalska, M.; Piekarska, A.; Kozielewicz, D.; Klos, K.; Rorat, M.; Bolewska, B.; Szymanek-Pasternak, A.; Mazur, W.; Lorenc, B.; Podlasin, R.; Sikorska, K.; Oczko-Grzesik, B.; Iwaszkiewicz, C.; Szetela, B.; Pabjan, P.; Pawlowska, M.; Tomasiewicz, K.; Polanska, J.; Jaroszewicz, J.

Background: Remdesivir (RDV) is the only antiviral drug registered currently for treatment of COVID-19 after a few clinical trials with controversial results. The purpose of this study was to evaluate the effectiveness and safety of RDV in patients with COVID-19 in real world settings. Methods: Patients were selected from 1496 individuals included in the SARSTer national database; 122 of them received therapy with RDV and 211 were treated with lopinavir/ritonavir (LPV/r)-based therapy. The primary end-point of effectiveness was clinical improvement in the ordinal 8-point scale, which was defined as a 2-point decrease from baseline to 7, 14, 21 and 28 days of hospitalization. The secondary end-points of effectiveness included: death rate, rate of no clinical improvement within 28 days of hospitalization in the ordinal scale, rate of the need for constant oxygen therapy, duration of oxygen therapy, rate of the need for mechanical ventilation, total hospitalization time, and rate of positive RT PCR for SARS-CoV-2 after 30 days. Findings: Significantly higher rates of clinical improvement, by 15% and 10% respectively, were observed after RDV treatment compared to LPV/r at days 21 and 28. The difference between regimens increased with worsening of oxygen saturation (SpO2) and depending on the baseline score from the ordinal scale. Statistically significant differences supporting RDV were also noted regarding the rate of no clinical improvement within 28 days of hospitalization and hospitalization duration in patients with baseline SpO2 [≤]90%. In the logistic regression model only the administration of remdesivir was independently associated with at least a 2-point improvement in the ordinal scale between baseline and day 21. Interpretation: In conclusion, data collected in this retrospective, observational, real world study supported use of remdesivir for treatment of SARS-CoV-2 infection particularly in patients with oxygen saturation [≤]95%.