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Clin Infect Dis
. 2024 Oct 15:ciae510.
doi: 10.1093/cid/ciae510. Online ahead of print. Remdesivir-associated survival outcomes among immunocompromised patients hospitalized for COVID-19: real-world evidence from the Omicron dominant era
Essy Mozaffari 1 , Aastha Chandak 2 , Robert L Gottlieb 3 4 5 6 , Chidinma Chima-Melton 7 8 , Mark Berry 1 , Alpesh N Amin 9 , Paul E Sax 10 , Andre C Kalil 11
Affiliations
Background: Patients with immunocompromising conditions are at an increased risk for coronavirus disease 2019 (COVID-19)-related hospitalizations and mortality. Randomized clinical trials provide limited enrollment, if any, to inform outcomes of such patients treated with remdesivir.
Methods: Using the US PINC AI Healthcare Database, we identified adult patients with immunocompromising conditions, hospitalized for COVID-19 between December 2021 and February 2024. Primary outcome was all-cause inpatient mortality examined in propensity score (PS) matched patients in remdesivir versus non-remdesivir groups. Subgroup analyses were performed for patients with cancer, hematologic malignancies, and solid organ/hematopoietic stem cell transplant recipients.
Results: Of 28,966 patients included in the study, 16,730 (58%) received remdesivir during first two days of hospitalization. After PS matching, 8,822 patients in remdesivir and 8,822 patients in non-remdesivir group were analyzed. Remdesivir was associated with a significantly lower mortality among patients with no supplemental oxygen (aHR [95% CI]: 14-day, 0.73 [0.62-0.86]; 28-day, 0.79 [0.68-0.91]) and among those with supplemental oxygen (14-day, 0.75 [0.67-0.85]; 28-day, 0.78 [0.70-0.86]). Remdesivir was also associated with lower mortality in subgroups of patients with cancer, hematological malignancies (including leukemia, lymphoma, and multiple myeloma), and solid organ/hematopoietic stem cell transplantation.
Conclusions: In this large cohort of patients with immunocompromising conditions hospitalized for COVID-19, remdesivir was associated with significant improvement in survival, including patients with varied underlying immunocompromising conditions. The integration of current real-world evidence into clinical guideline recommendations can inform clinical communities to optimize treatment decisions in the evolving COVID-19 era, extending beyond the conclusion of the public health emergency declaration.
Keywords: COVID-19; cancer; data science; hematological malignancy; immunocompromised; leukemia; lymphoma; multiple myeloma; propensity score; real-world data; remdesivir; transplantation.
. 2024 Oct 15:ciae510.
doi: 10.1093/cid/ciae510. Online ahead of print. Remdesivir-associated survival outcomes among immunocompromised patients hospitalized for COVID-19: real-world evidence from the Omicron dominant era
Essy Mozaffari 1 , Aastha Chandak 2 , Robert L Gottlieb 3 4 5 6 , Chidinma Chima-Melton 7 8 , Mark Berry 1 , Alpesh N Amin 9 , Paul E Sax 10 , Andre C Kalil 11
Affiliations
- PMID: 39405443
- DOI: 10.1093/cid/ciae510
Background: Patients with immunocompromising conditions are at an increased risk for coronavirus disease 2019 (COVID-19)-related hospitalizations and mortality. Randomized clinical trials provide limited enrollment, if any, to inform outcomes of such patients treated with remdesivir.
Methods: Using the US PINC AI Healthcare Database, we identified adult patients with immunocompromising conditions, hospitalized for COVID-19 between December 2021 and February 2024. Primary outcome was all-cause inpatient mortality examined in propensity score (PS) matched patients in remdesivir versus non-remdesivir groups. Subgroup analyses were performed for patients with cancer, hematologic malignancies, and solid organ/hematopoietic stem cell transplant recipients.
Results: Of 28,966 patients included in the study, 16,730 (58%) received remdesivir during first two days of hospitalization. After PS matching, 8,822 patients in remdesivir and 8,822 patients in non-remdesivir group were analyzed. Remdesivir was associated with a significantly lower mortality among patients with no supplemental oxygen (aHR [95% CI]: 14-day, 0.73 [0.62-0.86]; 28-day, 0.79 [0.68-0.91]) and among those with supplemental oxygen (14-day, 0.75 [0.67-0.85]; 28-day, 0.78 [0.70-0.86]). Remdesivir was also associated with lower mortality in subgroups of patients with cancer, hematological malignancies (including leukemia, lymphoma, and multiple myeloma), and solid organ/hematopoietic stem cell transplantation.
Conclusions: In this large cohort of patients with immunocompromising conditions hospitalized for COVID-19, remdesivir was associated with significant improvement in survival, including patients with varied underlying immunocompromising conditions. The integration of current real-world evidence into clinical guideline recommendations can inform clinical communities to optimize treatment decisions in the evolving COVID-19 era, extending beyond the conclusion of the public health emergency declaration.
Keywords: COVID-19; cancer; data science; hematological malignancy; immunocompromised; leukemia; lymphoma; multiple myeloma; propensity score; real-world data; remdesivir; transplantation.