Remdesivir shortens time to improvement, but has no signific
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Patients hospitalized with COVID-19 had shorter times to clinical improvement when treated with remdesivir, but the drug had no significant effect in a time-to-death analysis, even when given with corticosteroids, according to researchers.

Clinical effectiveness data on remdesivir are urgently needed, especially among diverse populations and in combination with other therapies.

This study aimed to examine whether remdesivir administered with or without corticosteroids for treatment of COVID-19 is associated with more rapid clinical improvement in a racially/ethnically diverse population.

In this retrospective comparative effectiveness research study, of 2483 individuals with confirmed severe acute respiratory syndrome coronavirus 2 infection assessed by polymerase chain reaction, those who received remdesivir were matched to infected individuals who did not receive remdesivir using time-invariant covariates (age, sex, race/ethnicity, Charlson Comorbidity Index, body mass index, and do-not-resuscitate or do-not-intubate orders) and time-dependent covariates (ratio of peripheral blood oxygen saturation to fraction of inspired oxygen, blood pressure, pulse, temperature, respiratory rate, C-reactive protein level, complete white blood cell count, lymphocyte count, albumin level, alanine aminotransferase level, glomerular filtration rate, dimerized plasmin fragment D [D-dimer] level, and oxygen device).

The primary outcome was rate of clinical improvement (hospital discharge or decrease of 2 points on the World Health Organization severity score), and the secondary outcome, mortality at 28 days. An additional outcome was clinical improvement and time to death associated with combined remdesivir and corticosteroid treatment.

Results:
-- Of 2483 consecutive admissions, 342 individuals received remdesivir, 184 of whom also received corticosteroids and 158 of whom received remdesivir alone.

-- For these 342 patients, the median age was 60 years (interquartile range, 46-69 years), 189 (55.3%) were men, and 276 (80.7%) self-identified as non-White race/ethnicity.

-- Remdesivir recipients had a shorter time to clinical improvement than matched controls without remdesivir treatment (median, 5.0 days vs 7.0 days).

-- Remdesivir recipients had a 28-day mortality rate of 7.7% (22 deaths) compared with 14.0% (40 deaths) among matched controls, but this difference was not statistically significant in the time-to-death analysis.

-- The addition of corticosteroids to remdesivir was not associated with a reduced hazard of death at 28 days.

Conclusively, in this comparative effectiveness research study of adults hospitalized with COVID-19, receipt of remdesivir was associated with faster clinical improvement in a cohort of predominantly non-White patients. Remdesivir plus corticosteroid administration did not reduce the time to death compared with remdesivir administered alone.

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2777863
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