Real-World Effectiveness of Remdesivir in Adults Hospitalized With Coronavirus Disease 2019 (COVID-19): A Retrospective, Multicenter Comparative Effectiveness Study
Real-World Effectiveness of Remdesivir in Adults Hospitalized With Coronavirus Disease 2019 (COVID-19): A Retrospective, Multicenter Comparative Effectiveness Study
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DOI：
10.1093/cid/ciab1035
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发表时间：
2022-02-25
影响因子：
11.8
通讯作者：
Xu, Yanxun
中科院分区：
文献类型：
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作者：
Garibaldi, Brian T.;Wang, Kunbo;Xu, Yanxun
背景目前迫切需要了解瑞德西韦治疗严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）的真实有效性。这是一项回顾性比较有效性研究。纳入了2020年2月23日至2021年2月11日期间在美国一家大型私人医疗保健网络住院的个人，其SARS-CoV-2和ICD-10诊断代码检测呈阳性，与2019年症状性冠状病毒病（COVID-19）一致。使用时间依赖性倾向评分将Remdesivir接受者与对照组相匹配。主要结局是改善时间，次要结局是死亡时间。在96859名COVID-19患者中，42473名（43.9%）接受了至少1剂Remdesivir。Remdesivir接受者的中位年龄为65岁，23 701人（55.8%）为男性，22 819人（53.7%）为非白人。18328例患者（43.2%）匹配。Remdesivir接受者在28天内获得临床改善的可能性显著更大（校正风险比[aHR] 1.19，95%置信区间[CI]，1.16-1.22）。接受无氧（aHR 1.30，95% CI，1.22-1.38）或低流量氧（aHR 1.23，95% CI，1.19-1.27）治疗的Remdesivir患者在28天内获得临床改善的可能性显著更高。对总体死亡可能性无显著影响（aHR 1.02，95% CI，0.97 -1.08）。与对照组相比，接受低流量氧气治疗的Remdesivir患者死亡的可能性显著降低（aHR 0.85，95%CI，0.77 - 0.92; Remdesivir患者28天死亡率为8.4% [865例死亡]，对照组为12.5% [1334例死亡]）。这些结果支持将Remdesivir用于住院的COVID-19患者，无需或低流量氧气。在病情较重的患者中常规开始使用Remdesivir不太可能是有益的。Remdesivir与无氧或低流量氧患者临床改善的可能性增加以及低流量氧患者死亡率降低显著相关。在病情较重的患者中常规使用remdesivir不太可能有益。
Background. There is an urgent need to understand the real-world effectiveness of remdesivir in the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Methods. This was a retrospective comparative effectiveness study. Individuals hospitalized in a large private healthcare network in the United States from 23 February 2020 through 11 February 2021 with a positive test for SARS-CoV-2 and ICD-10 diagnosis codes consistent with symptomatic coronavirus disease 2019 (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 1 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 [aHR] 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, .97-1.08). Remdesivir recipients on low-flow oxygen were significantly less likely to die than controls (aHR 0.85, 95% CI, .77-.92; 28-day mortality 8.4% [865 deaths] for remdesivir patients, 12.5% [1334 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.Remdesivir was significantly associated with an increased likelihood of clinical improvement in patients on no or low-flow oxygen and a reduction in mortality among individuals on low-flow oxygen. Routine use of remdesivir in sicker patients is unlikely to be beneficial.