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Use and effectiveness of remdesivir for the treatment of patients with covid-19 using data from the Lean European Open Survey on SARS-CoV-2 infected patients (LEOSS): a multicentre cohort study.

Authors :
Pilgram, Lisa
Appel, Katharina S.
Ruethrich, Maria M.
Koll, Carolin E. M.
Vehreschild, Maria J. G. T.
de Miranda, Susana M. Nunes
Hower, Martin
Hellwig, Kerstin
Hanses, Frank
Wille, Kai
Haselberger, Martina
Spinner, Christoph D.
Vom Dahl, Juergen
Hertenstein, Bernd
Westhoff, Timm
Vehreschild, J. Janne
Jensen, Björn-Erik Ole
Stecher, Melanie
Source :
Infection; Aug2023, Vol. 51 Issue 4, p1033-1049, 17p, 8 Charts, 2 Graphs
Publication Year :
2023

Abstract

Objectives: The use of remdesivir (RDV) as the first drug approved for coronavirus disease 2019 (COVID-19) remains controversial. Based on the Lean European Open Survey on severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infected patients (LEOSS), we aim to contribute timing-focused complementary real-world insights to its evaluation. Methods: SARS-CoV-2 infected patients between January 2020 and December 2021 treated with RDV were matched 1:1 to controls considering sociodemographics, comorbidities and clinical status. Multiple imputations were used to account for missing data. Effects on fatal outcome were estimated using uni- and multivariable Cox regression models. Results: We included 9,687 patients. For those starting RDV administration in the complicated phase, Cox regression for fatal outcome showed an adjusted hazard ratio (aHR) of 0.59 (95%CI 0.41–0.83). Positive trends could be obtained for further scenarios: an aHR of 0.51 (95%CI 0.16–1.68) when RDV was initiated in uncomplicated and of 0.76 (95% CI 0.55–1.04) in a critical phase of disease. Patients receiving RDV with concomitant steroids exhibited a further reduction in aHR in both, the complicated (aHR 0.50, 95%CI 0.29–0.88) and critical phase (aHR 0.63, 95%CI 0.39–1.02). Conclusion: Our study results elucidate that RDV use, in particular when initiated in the complicated phase and accompanied by steroids is associated with improved mortality. However, given the limitations of non-randomized trials in estimating the magnitude of the benefit of an intervention, further randomized trials focusing on the timing of therapy initiation seem warranted. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
03008126
Volume :
51
Issue :
4
Database :
Complementary Index
Journal :
Infection
Publication Type :
Academic Journal
Accession number :
164982777
Full Text :
https://doi.org/10.1007/s15010-023-01994-0