Dataset Information

Remdesivir reduced mortality in immunocompromised patients hospitalized for COVID-19 across variant waves: Findings from routine clinical practice.

ABSTRACT:

Background

Immunocompromised patients are at high risk of severe COVID-19 and death, yet treatment strategies for immunocompromised patients hospitalized for COVID-19 reflect variations in clinical practice. This comparative effectiveness study investigated the effect of remdesivir treatment on inpatient mortality among immunocompromised patients hospitalized for COVID-19 across all variants of concern (VOC) periods.

Methods

Data for immunocompromised patients hospitalized for COVID-19 between December 2020 and April 2022 were extracted from the US PINC AI Healthcare Database. Patients initiating remdesivir within two days of hospitalization were matched 1:1 using propensity score matching with replacement to patients who did not receive remdesivir during their hospitalization for COVID-19. Additional matching criteria included admission month, age group, and hospital. Cox Proportional Hazards models were used to examine the effect of remdesivir on risk of 14- and 28-day mortality during VOC periods.

Results

A total of 19,184 remdesivir patients were matched to 11,213 non-remdesivir patients. Overall, 11.1% and 17.7% of remdesivir patients died within 14 and 28 days, respectively, compared with 15.4% and 22.4% of non-remdesivir patients. Remdesivir was associated with a reduction in mortality at 14 days (hazard ratio [95% confidence interval]: 0.70 [0.62-0.78]) and 28 days (0.75 [0.68-0.83]). Survival benefit remained significant during the Pre-Delta, Delta, and Omicron time-periods.

Conclusions

Prompt initiation of remdesivir in immunocompromised patients hospitalized for COVID-19 is associated with significant survival benefit across all variant waves. These findings provide much-needed evidence relating to the effectiveness of a foundational treatment for hospitalized COVID-19 patients among a high-risk population.

SUBMITTER: Mozaffari E

PROVIDER: S-EPMC10724457 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

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Publications

Remdesivir Reduced Mortality in Immunocompromised Patients Hospitalized for COVID-19 Across Variant Waves: Findings From Routine Clinical Practice.

Mozaffari Essy E Chandak Aastha A Gottlieb Robert L RL Chima-Melton Chidinma C Read Stephanie H SH Jiang Heng H Chiang Mel M Lee EunYoung E Gupta Rikisha R Berry Mark M Kalil Andre C AC

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20231201 12

<h4>Background</h4>Immunocompromised patients are at high risk of severe coronavirus disease 2019 (COVID-19) and death, yet treatment strategies for immunocompromised patients hospitalized for COVID-19 reflect variations in clinical practice. In this comparative effectiveness study, we investigated the effect of remdesivir treatment on inpatient mortality among immunocompromised patients hospitalized for COVID-19 across all variants of concern (VOC) periods.<h4>Methods</h4>Data for immunocomprom ...[more]

PMID: 37556727

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Project description:ImportanceSARS-CoV-2, which causes COVID-19, poses considerable morbidity and mortality risks. Studies using data collected during routine clinical practice can supplement randomized clinical trials to provide needed evidence, especially during a global pandemic, and can yield markedly larger sample sizes to assess outcomes for important patient subgroups.ObjectiveTo evaluate the association of remdesivir treatment with inpatient mortality among patients with COVID-19 outside of the clinical trial setting.Design, setting, and participantsA retrospective cohort study in US hospitals using health insurance claims data linked to hospital chargemaster data from December 1, 2018, to May 3, 2021, was conducted among 24 856 adults hospitalized between May 1, 2020, and May 3, 2021, with newly diagnosed COVID-19 who received remdesivir and 24 856 propensity score-matched control patients.ExposureRemdesivir treatment.Main outcomes and measuresAll-cause inpatient mortality within 28 days of the start of remdesivir treatment for the remdesivir-exposed group or the matched index date for the control group.ResultsA total of 24 856 remdesivir-exposed patients (12 596 men [50.7%]; mean [SD] age, 66.8 [15.4] years) and 24 856 propensity score-matched control patients (12 621 men [50.8%]; mean [SD] age, 66.8 [15.4] years) were included in the study. Median follow-up was 6 days (IQR, 4-11 days) in the remdesivir group and 5 days (IQR, 2-10 days) in the control group. There were 3557 mortality events (14.3%) in the remdesivir group and 3775 mortality events (15.2%) in the control group. The 28-day mortality rate was 0.5 per person-month in the remdesivir group and 0.6 per person-month in the control group. Remdesivir treatment was associated with a statistically significant 17% reduction in inpatient mortality among patients hospitalized with COVID-19 compared with propensity score-matched control patients (hazard ratio, 0.83 [95% CI, 0.79-0.87]).Conclusions and relevanceIn this retrospective cohort study using health insurance claims and hospital chargemaster data, remdesivir treatment was associated with a significantly reduced inpatient mortality overall among patients hospitalized with COVID-19. Results of this analysis using data collected during routine clinical practice and state-of-the-art methods complement results from randomized clinical trials. Future areas of research include assessing the association of remdesivir treatment with inpatient mortality during the circulation of different variants and relative to time from symptom onset.