Remdesivir Use Compared to Supportive Care in Hospitalized Patients with Severe COVID-19: A Single-Center Experience

Kalligeros, Markos; Tashima, Karen T; Mylona, Evangelia K; Rybak, Natasha; Flanigan, Timothy P; Farmakiotis, Dimitrios; Beckwith, Curt G; Sanchez, Martha; Neill, Marguerite; Johnson, Jennie E; Garland, Joseph M; Aung, Su; Byrd, Katrina M; O’Brien, Thomas; Pandita, Aakriti; Aridi, Jad; Macias Gil, Raul; Larkin, Jerome; Shehadeh, Fadi; Mylonakis, Eleftherios

BACKGROUND: The US Food and Drug Administration issued an Emergency Use Authorization for remdesivir use in patients with severe COVID-19. METHODS: We utilized data from two quaternary, acute care hospitals. The outcomes of interest were the impact of remdesivir on in-hospital death by day 28 as well as time to recovery, clinical improvement, and discharge. We utilized Cox proportional hazards models and stratified log-rank tests. RESULTS: 224 patients were included in the study. Median age was 59 years; 67.0% were male; 17/125 patients (13.6%) who received supportive care and 7/99 patients (7.1%) who received remdesivir died. The unadjusted risk for 28-day in-hospital death was lower for patients who received remdesivir compared to patients who received supportive care (HR 0.42; 95% CI: 0.16-1.08). Although this trend remained the same after adjusting for age, sex, race and oxygen requirements on admission (aHR 0.49; 95% CI: 0.19-1.28), as well as chronic comorbidities and use of corticosteroids (aHR 0.44; 95% CI: 0.16-1.23), it did not reach statistical significance. The use of remdesivir was not associated with an increased risk of acute kidney injury (AKI) and liver test abnormalities. Although not statistically significant, the rate ratios for time to recovery, clinical improvement, and discharge were higher in women and Black or African American patients. CONCLUSION: Patients on remdesivir had lower, albeit not significant, all-cause in hospital mortality, and the use of remdesivir did not increase the risk for AKI. Promising signals from this study need to be confirmed by future placebo-controlled randomized clinical trials.