Clinical outcomes by supplemental oxygen use in remdesivir-treated, hospitalised adults with COVID-19

Nadir Arber*, Pallav L. Shah, Lambert Assoumou, Casper Rokx, Nathalie De Castro, Ameet Bakhai, Alex Soriano Viladomiu, Lourdes Mateu, Carlos Lumbreras, Vicente Estrada, Adrian Curran, Pierre Olivier Sellier, Annie Duffy, Carl Fletcher, Essy Mozaffari, Richard Haubrich, Paul Hodgkins, Anton Pozniak, Francois Raffi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Clinical trials show different effects of remdesivir on clinical outcomes relative to COVID-19 severity at hospital admission; in Europe, there are few real-world data. Methods: A multicentre, multinational retrospective cohort study in adult patients hospitalised with PCR-confirmed COVID-19 was conducted to understand remdesivir clinical use in different countries and to describe outcomes for patients receiving remdesivir stratified by oxygen use. Primary endpoints were all-cause mortality at day 28 and hospitalisation duration. Patients were categorised by baseline disease severity: no supplemental oxygen (NSO); low flow oxygen ≤ 6 litres (l)/minute (LFO); high flow oxygen > 6 l/minute (HFO). Results: Four hundred and forty-eight (448) patients (72 [16.1%] HFO; 295 [65.8%] LFO; 81 (18.1%] NSO) were included; median age was 65 years and 64% were male. Mortality was higher in patients on HFO (rate 23.6%) compared to LFO (10.2%; p = 0.001) or NSO (6.2%; p = 0.002). Duration of hospitalisation was longer in patients on HFO (13 days) compared to LFO (9 days; p = 0.003) and NSO (9 days; p = 0.021). Patients who initiated remdesivir ≥ 2 days compared to within a day of hospitalisation had a 4.2 times higher risk of death, irrespective of age, sex, comorbidities, and oxygen support at baseline. Requirement for mechanical ventilation/ECMO and readmission within 28 days of discharge was similar across groups. Remdesivir use and outcomes differed by country. Conclusions: A higher mortality rate and duration of hospitalisation was seen in remdesivir-treated COVID-19 patients on HFO compared to LFO and NSO. Initiation of remdesivir upon admission as opposed to delayed initiation has a mortality benefit. Clinical Trials Registration: NCT04847622.

Original languageEnglish
Article number104760
JournalInfectious Diseases Now
Volume53
Issue number7
DOIs
StatePublished - Oct 2023
Externally publishedYes

Keywords

  • COVID-19
  • Mortality
  • Outcome
  • Remdesivir
  • Supplemental oxygen

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