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Oxford University Press - PMC COVID-19 Collection logoLink to Oxford University Press - PMC COVID-19 Collection
. 2021 Dec 15:ciab1035. doi: 10.1093/cid/ciab1035

Real-World Effectiveness Of Remdesivir In Adults Hospitalized With Covid-19: A Retrospective, Multicenter Comparative Effectiveness Study

Brian T Garibaldi 1,2,, Kunbo Wang 2,3, Matthew L Robinson 2,4, Joshua Betz 2,5, G Caleb Alexander 2,6,7, Kathleen M Andersen 2,6,7, Corey S Joseph 2,6,7, Hemalkumar B Mehta 2,6,7, Kimberly Korwek 2,8, Kenneth E Sands 2,8, Arielle M Fisher 2,9, Robert C Bollinger 2,4, Yanxun Xu 2,3,10
PMCID: PMC8754724  PMID: 34910128

Abstract

Background

There is an urgent need to understand the real-world effectiveness of remdesivir in the treatment of SARS-CoV-2.

Methods

This was a retrospective comparative effectiveness study. Individuals hospitalized in a large private healthcare network in the US from February 23, 2020 through February 11, 2021 with a positive test for SARS-CoV-2 and ICD-10 diagnosis codes consistent with symptomatic COVID-19 were included. Remdesivir recipients were matched to controls using time-dependent propensity scores. The primary outcome was time to improvement with a secondary outcome of time to death.

Results

Of 96,859 COVID-19 patients, 42,473 (43.9%) received at least one remdesivir dose. The median age of remdesivir recipients was 65 years, 23,701 (55.8%) were male and 22,819 (53.7%) were non-white. Matches were found for 18,328 patients (43.2%). Remdesivir recipients were significantly more likely to achieve clinical improvement by 28 days (adjusted hazard ratio [1.19, 95% confidence interval (CI), 1.16-1.22]). Remdesivir patients on no oxygen (aHR 1.30, 95% CI 1.22-1.38) or low-flow oxygen (aHR 1.23, 95% CI 1.19-1.27) were significantly more likely to achieve clinical improvement by 28 days. There was no significant impact on the likelihood of mortality overall (aHR 1.02, 95% CI 0.97-1.08). Remdesivir recipients on low-flow oxygen were significantly less likely to die than controls (aHR 0.85, 95% CI 0.77-0.92; 28-day mortality 8.4% [865 deaths] for remdesivir patients, 12.5% [1,334 deaths] for controls).

Conclusions

These results support the use of remdesivir for hospitalized COVID-19 patients on no or low-flow oxygen. Routine initiation of remdesivir in more severely ill patients is unlikely to be beneficial.

Keywords: remdesivir, COVID-19, SARS-CoV-2, real-world effectiveness, therapeutics

Supplementary Material

ciab1035_suppl_Supplementary_Material

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

ciab1035_suppl_Supplementary_Material

Articles from Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America are provided here courtesy of Oxford University Press

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