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While prompt administration of the antiviral drug remdesivir can shorten time to recovery in hospitalized patients with COVID-19 (NEJM JW Infect Dis Dec 2020 and N Engl J Med 2020; 383:1813), the impact of this agent on mortality remains unclear (although such benefit would be anticipated with earlier use). Garcia-Vidal et al performed a retrospective study of patients hospitalized for ≥48 hours at a large teaching hospital in Barcelona. They analyzed the timing of remdesivir use in relation to pre-admission symptom duration as a predictor of 30-day mortality.
Among 2607 patients, 438 received remdesivir, 476 were admitted to the ICU, and 264 required invasive mechanical ventilation (IMV). Thirty-day mortality was 10.7% overall (4.3% among remdesivir recipients; 12.0% among non-recipients). Median pre-admission symptom duration was 7 days. Among 577 patients admitted with ≤3 days of symptoms, mortality was 6.6% (remdesivir) versus 23.0% (no remdesivir; P=0.001). Among 696 with 4–6 days of symptoms, mortality was 3.3% (remdesivir) versus 12.0% (no remdesivir; P=0.001). In 1334 with >6 days of symptoms, mortality was 3.7% (remdesivir) versus 7.8% (no remdesivir; P=0.085). Factors predicting mortality included age >66, renal failure, short duration of pre-admission symptoms (i.e., ≤3 days and 4–6 days), and need for IMV. Remdesivir provided significant protection against death (odds ratio, 0.382).
Garcia-Vidal C et al. Impact of remdesivir according to the pre-admission symptom duration in patients with COVID-19. J Antimicrob Chemother 2021 Sep 2; [e-pub]. (https://doi.org/10.1093/jac/dkab321)
Comment
This study clarifies that remdesivir therapy appears to be highly beneficial during the early stages of COVID-19, particularly in patients with the shortest pre-admission symptom duration (and the highest mortality risk). The challenge now is that most patients with COVID-19 who present for admission have had symptoms for at least 6 days. However, going forward, we may see more patients with earlier symptoms thanks to the public's awareness of the disease and the growing array of upcoming therapies that would make timely clinical presentation worthwhile.