The antiviral drug remdesivir cut death rates 17% to 25% in adults hospitalized for COVID-19 who didn't require supplemental oxygen at admission, suggests a large US study published yesterday in Open Forum Infectious Diseases.
The study, led by researchers from remdesivir (Veklury) developer Gilead Sciences, used a multicenter US hospital billing database to compare rates of in-hospital death among 58,188 patients on room air who received at least one dose of remdesivir within the first 2 days of hospital admission and 17,574 matched patients not given the drug. The drug is most effective when given early in infection, when viral replication is most active.
Prior studies based on early-pandemic data
The study period, December 2020 to April 2022, spanned the predominance of the pre-Delta (eg, Alpha, Beta), Delta, and Omicron SARS-CoV-2 variants of concern (VOC).
The study authors noted that previous trials have shown remdesivir to be safe and effective in reducing death rates in hospitalized COVID-19 patients, regardless of the need for supplemental oxygen, and in cutting hospitalization and death rates in nonhospitalized patients at risk for severe illness.
"Nonetheless, much of the evidence relating to remdesivir effectiveness, including real-world studies, is based on data from the early phase of the COVID-19 pandemic," they wrote. "Since then, there has been an emergence of VOC, improvements in standards of care through the approval and authorization of different therapeutics, and widespread initial and follow-up vaccination."
Findings held across all variants
In total, 5.4% of remdesivir-treated and 7.3% of non-remdesivir patients died within 14 days, and 8.0% and 9.8%, respectively, died by 28 days. Remdesivir therapy was tied to a statistically significant reduction in inpatient death relative to remdesivir nonreceipt (14-day adjusted hazard ratio [aHR], 0.75; 28-day aHR, 0.83), translating to a 25% and 17% reduction in risk of death for the two time spans, respectively.
These findings highlight a potential survival benefit when clinicians initiated remdesivir upon admission across the dominant variant eras of the evolving pandemic.
During each VOC period, remdesivir therapy was linked to a significant decline in in-hospital death relative to remdesivir nonreceipt for both 14-day (pre-Delta aHR, 0.73; Delta aHR, 0.80; Omicron aHR, 0.73) and 28-day risk of death (aHRs, 0.83, 0.87, and 0.76, respectively).
"These findings highlight a potential survival benefit when clinicians initiated remdesivir upon admission across the dominant variant eras of the evolving pandemic," the researchers concluded. "Conducting a randomized controlled trial appropriately powered for mortality is impractical in this patient population."
