tetano
Editor, Senior Moderator
Infection
. 2023 Feb 10.
doi: 10.1007/s15010-023-01994-0. Online ahead of print.
Use and effectiveness of remdesivir for the treatment of patients with covid-19 using data from the Lean European Open Survey on SARS-CoV-2 infected patients (LEOSS): a multicentre cohort study
Lisa Pilgram[SUP] #[/SUP][SUP] 1 2 3 [/SUP], Katharina S Appel[SUP] #[/SUP][SUP] 4 [/SUP], Maria M Ruethrich[SUP] 5 [/SUP], Carolin E M Koll[SUP] 6 7 [/SUP], Maria J G T Vehreschild[SUP] 8 [/SUP], Susana M Nunes de Miranda[SUP] 6 [/SUP], Martin Hower[SUP] 9 10 [/SUP], Kerstin Hellwig[SUP] 11 [/SUP], Frank Hanses[SUP] 12 13 [/SUP], Kai Wille[SUP] 14 [/SUP], Martina Haselberger[SUP] 15 [/SUP], Christoph D Spinner[SUP] 16 [/SUP], Juergen Vom Dahl[SUP] 17 [/SUP], Bernd Hertenstein[SUP] 18 [/SUP], Timm Westhoff[SUP] 19 [/SUP], J Janne Vehreschild[SUP] 6 7 4 [/SUP], Björn-Erik Ole Jensen[SUP] #[/SUP][SUP] 20 [/SUP], Melanie Stecher[SUP] #[/SUP][SUP] 6 7 [/SUP]
Affiliations
Abstract
Objectives: The use of remdesivir (RDV) as the first drug approved for coronavirus disease 2019 (COVID-19) remains controversial. Based on the Lean European Open Survey on severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infected patients (LEOSS), we aim to contribute timing-focused complementary real-world insights to its evaluation.
Methods: SARS-CoV-2 infected patients between January 2020 and December 2021 treated with RDV were matched 1:1 to controls considering sociodemographics, comorbidities and clinical status. Multiple imputations were used to account for missing data. Effects on fatal outcome were estimated using uni- and multivariable Cox regression models.
Results: We included 9,687 patients. For those starting RDV administration in the complicated phase, Cox regression for fatal outcome showed an adjusted hazard ratio (aHR) of 0.59 (95%CI 0.41-0.83). Positive trends could be obtained for further scenarios: an aHR of 0.51 (95%CI 0.16-1.68) when RDV was initiated in uncomplicated and of 0.76 (95% CI 0.55-1.04) in a critical phase of disease. Patients receiving RDV with concomitant steroids exhibited a further reduction in aHR in both, the complicated (aHR 0.50, 95%CI 0.29-0.88) and critical phase (aHR 0.63, 95%CI 0.39-1.02).
Conclusion: Our study results elucidate that RDV use, in particular when initiated in the complicated phase and accompanied by steroids is associated with improved mortality. However, given the limitations of non-randomized trials in estimating the magnitude of the benefit of an intervention, further randomized trials focusing on the timing of therapy initiation seem warranted.
Keywords: COVID-19; Pandemic; Remdesivir; SARS-CoV-2; Steroid.
. 2023 Feb 10.
doi: 10.1007/s15010-023-01994-0. Online ahead of print.
Use and effectiveness of remdesivir for the treatment of patients with covid-19 using data from the Lean European Open Survey on SARS-CoV-2 infected patients (LEOSS): a multicentre cohort study
Lisa Pilgram[SUP] #[/SUP][SUP] 1 2 3 [/SUP], Katharina S Appel[SUP] #[/SUP][SUP] 4 [/SUP], Maria M Ruethrich[SUP] 5 [/SUP], Carolin E M Koll[SUP] 6 7 [/SUP], Maria J G T Vehreschild[SUP] 8 [/SUP], Susana M Nunes de Miranda[SUP] 6 [/SUP], Martin Hower[SUP] 9 10 [/SUP], Kerstin Hellwig[SUP] 11 [/SUP], Frank Hanses[SUP] 12 13 [/SUP], Kai Wille[SUP] 14 [/SUP], Martina Haselberger[SUP] 15 [/SUP], Christoph D Spinner[SUP] 16 [/SUP], Juergen Vom Dahl[SUP] 17 [/SUP], Bernd Hertenstein[SUP] 18 [/SUP], Timm Westhoff[SUP] 19 [/SUP], J Janne Vehreschild[SUP] 6 7 4 [/SUP], Björn-Erik Ole Jensen[SUP] #[/SUP][SUP] 20 [/SUP], Melanie Stecher[SUP] #[/SUP][SUP] 6 7 [/SUP]
Affiliations
- PMID: 36763285
- DOI: 10.1007/s15010-023-01994-0
Abstract
Objectives: The use of remdesivir (RDV) as the first drug approved for coronavirus disease 2019 (COVID-19) remains controversial. Based on the Lean European Open Survey on severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infected patients (LEOSS), we aim to contribute timing-focused complementary real-world insights to its evaluation.
Methods: SARS-CoV-2 infected patients between January 2020 and December 2021 treated with RDV were matched 1:1 to controls considering sociodemographics, comorbidities and clinical status. Multiple imputations were used to account for missing data. Effects on fatal outcome were estimated using uni- and multivariable Cox regression models.
Results: We included 9,687 patients. For those starting RDV administration in the complicated phase, Cox regression for fatal outcome showed an adjusted hazard ratio (aHR) of 0.59 (95%CI 0.41-0.83). Positive trends could be obtained for further scenarios: an aHR of 0.51 (95%CI 0.16-1.68) when RDV was initiated in uncomplicated and of 0.76 (95% CI 0.55-1.04) in a critical phase of disease. Patients receiving RDV with concomitant steroids exhibited a further reduction in aHR in both, the complicated (aHR 0.50, 95%CI 0.29-0.88) and critical phase (aHR 0.63, 95%CI 0.39-1.02).
Conclusion: Our study results elucidate that RDV use, in particular when initiated in the complicated phase and accompanied by steroids is associated with improved mortality. However, given the limitations of non-randomized trials in estimating the magnitude of the benefit of an intervention, further randomized trials focusing on the timing of therapy initiation seem warranted.
Keywords: COVID-19; Pandemic; Remdesivir; SARS-CoV-2; Steroid.