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Randomized clinical trials have found that remdesivir use in patients hospitalized with COVID-19 hastens clinical recovery (NEJM JW Infect Dis Dec 2020 and N Engl J Med 2020; 383:1813) and, in those not yet requiring mechanical ventilation, reduces mortality (NEJM JW Infect Dis Jul 2022 and Lancet 2022; 399:P1941). Now, in a manufacturer-funded retrospective cohort study, investigators assess the real-world impact of remdesivir use on mortality among patients hospitalized with COVID-19 in the U.S. between May 2020 and May 2021.
Data for this study were obtained from health insurance claims and hospital chargemaster data. A total of 24,856 patients initiating remdesivir were compared to an equal number of propensity score-matched control patients who had not initiated remdesivir on the day of matching (but may have started the drug later during hospitalization). At baseline, approximately 70% of patients received corticosteroids but only about 36% were reported as requiring any oxygen supplementation (the rest were initially on room air). Mortality was 14% in the remdesivir group and 15% in the control group. Remdesivir use was associated with a 17% reduction in inpatient mortality.
Chokkalingam AP et al. Association of remdesivir treatment with mortality among hospitalized adults with COVID-19 in the United States. JAMA Netw Open 2022 Dec 1; 5:e2244505. (https://doi.org/10.1001/jamanetworkopen.2022.44505)
Comment
This retrospective cohort study has important limitations. Corticosteroids are only recommended for patients with COVID-19 who require oxygen, yet in this study corticosteroid use was much higher than use of oxygen supplementation, raising concern for incomplete data ascertainment. In addition, residual or unmeasured confounding may have skewed the results. In patients hospitalized with COVID-19 who are early in their disease course, I recommend use of remdesivir, but that approach is informed by results from previous randomized trials rather than the current study.