1. Remdesivir treatment and clinical outcome in non-severe hospitalized COVID-19 patients: a propensity score matching multicenter Italian hospital experience.
- Author
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Attena, Emilio, Caturano, Alfredo, Annunziata, Anna, Maraolo, Alberto Enrico, De Rosa, Annunziata, Fusco, Francesco Maria, Halasz, Geza, Dall'Ospedale, Valeria, Conte, Maddalena, Parisi, Valentina, Galiero, Raffaele, Sasso, Ferdinando Carlo, Fiorentino, Giuseppe, and Russo, Vincenzo
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DRUG efficacy , *COVID-19 , *CONFIDENCE intervals , *INTUBATION , *LOG-rank test , *PHARMACOLOGY , *ANTIVIRAL agents , *RETROSPECTIVE studies , *ACQUISITION of data , *TREATMENT effectiveness , *SEVERITY of illness index , *COMPARATIVE studies , *ADULT respiratory distress syndrome , *HOSPITAL mortality , *MEDICAL records , *KAPLAN-Meier estimator , *DESCRIPTIVE statistics , *BRADYCARDIA , *LOGISTIC regression analysis , *ODDS ratio , *PROBABILITY theory , *DISEASE risk factors , *EVALUATION - Abstract
Introduction: Remdesivir exerts positive effects on clinical improvement, even though it seems not to affect mortality among COVID-19 patients; moreover, it was associated with the occurence of marked bradycardia. Methods: We retrospectively evaluated 989 consecutive patients with non-severe COVID-19 (SpO2 ≥ 94% on room air) admitted from October 2020 to July 2021 at five Italian hospitals. Propensity score matching allowed to obtain a comparable control group. Primary endpoints were bradycardia onset (heart rate < 50 bpm), acute respiratory distress syndrome (ARDS) in need of intubation and mortality. Results: A total of 200 patients (20.2%) received remdesivir, while 789 standard of care (79.8%). In the matched cohorts, severe ARDS in need of intubation was experienced by 70 patients (17.5%), significantly higher in the control group (68% vs. 31%; p < 0.0001). Conversely, bradycardia, experienced by 53 patients (12%), was significantly higher in the remdesivir subgroup (20% vs. 1.1%; p < 0.0001). During follow-up, all-cause mortality was 15% (N = 62), significantly higher in the control group (76% vs. 24%; log-rank p < 0.0001), as shown at the Kaplan–Meier (KM) analysis. KM furthermore showed a significantly higher risk of severe ARDS in need of intubation among controls (log-rank p < 0.001), while an increased risk of bradycardia onset in the remdesivir group (log-rank p < 0.001). Multivariable logistic regression showed a protective role of remdesivir for both ARDS in need of intubation (OR 0.50, 95%CI 0.29–0.85; p = 0.01) and mortality (OR 0.18, 95%CI 0.09–0.39; p < 0.0001). Conclusions: Remdesivir treatment emerged as associated with reduced risk of severe acute respiratory distress syndrome in need of intubation and mortality. Remdesivir-induced bradycardia was not associated with worse outcome. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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