REMDESIVIR ASSOCIATED BRADYCARDIA AND OUTCOMES IN COVID-19 PATIENTS: A MULTICENTER RETROSPECTIVE STUDY

Background

Antiviral agents, such as remdesivir, have shown promising results in helping reduce the morbidity and healthcare burden of COVID-19 in hospitalized patients. However, an increasing number of studies have reported a relationship between Remdesivir and bradycardia. Therefore, this study aims to analyze the relationship between bradycardia and outcomes in patients on remdesivir.

Methods

We conducted a retrospective study of 2,935 consecutive COVID-19 patients admitted to seven hospitals in Southern California in the United States between January 2020 and August 2021. First, we did a backward logistic regression to analyze the relationship between remdesivir use and other independent variables. Finally, we did a backward selection Cox multivariate regression analysis on the sub-group of patients who received remdesivir to evaluate the mortality risk in bradycardic patients on remdesivir.

Results

The mean age of the study population was 63 years; 56% were males, 44% received remdesivir, and 52% developed bradycardia. Our analysis showed that remdesivir was associated with increased odds of bradycardia (OR 1.9, p<0.001). Patients that were on remdesivir in our study were sicker patients with increased odds of having elevated CRP (OR 1.03, p<0.001), elevated WBC on admission (OR 1.06, p<0.001), and increased length of hospital stay (OR 1.02, p=0.002). However, remdesivir was associated with a decreased odds of mechanical ventilation (OR 0.53, p<0.001). In the sub-group analysis comparing bradycardia and non-bradycardia patients that received remdesivir, bradycardia was associated with decreased mortality risk (HR 0.69, p=0.002).

Conclusion

Our study showed that remdesivir was associated with bradycardia in COVID-19 patients. However, it decreased the odds of being on a ventilator, even in patients with increased inflammatory markers on admission. Furthermore, patients on remdesivir that developed bradycardia did not have any increased risk of death. Therefore, clinicians should not withhold remdesivir from patients at risk of developing bradycardia because bradycardia in such patients was not found to worsen the clinical outcome.