Abstract
ObjectivesRemdesivir is one of the most widely recommended and used medications for COVID-19 treatment. However, different outcomes have been reported for hospitalized patients with COVID-19 treated with remdesivir. Specifically, the effect of the timing of remdesivir initiation (from patient’s symptom onset) on clinical outcomes in COVID-19 patients has not been investigated.MethodsThis is a retrospective cohort study of patients hospitalized with COVID-19 and treated with or without remdisivir. The primary outcome was patient’s recovery rate, defined as clinical improvement and patient’s discharge by day 14 of symptom onset. The secondary outcome was the need for intensive care unit (ICU) admission, mechanical ventilation, and mortality within 28 days of patient’s symptom onset.ResultsOut of 323 hospitalized adults with COVID-19, 107 (33.1%) received no remdesivir during their hospital stay, 107 (33.1%) received remdesivir early within 7 days of the symptom onset, and 109 (33.7%) received it at 8 days or later of symptom onset. At day 14 following symptom onset, higher proportion of patients recovered in the early remdesivir compared to the late remdesivir cohort, or patients who did not receive remdesivir (adjusted odds ratio, aOR, 2.65; 95% confidence interval [CI], 1.31 to 5.35). Moreover, early administration of remdesivir was associated with lower admission to intensive care unit (adjusted hazard ratio [aHR], 0.31; 95% CI, 0.15 to 0.64), less need for mechanical ventilation (aHR, 0.22; 95% CI, 0.10 to 0.51), and lower mortality at 28 days (aHR, 0.15; 95% CI, 0.04 to 0.53), as compared to the late remdesivir cohort or patients who did not receive remdesivir.ConclusionEarly administration of remdesivir within 7 days of symptom onset is associated with less need for mechanical ventilation and lower 28-days mortality.
Highlights
COVID-19, a respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2), was first identified in December 2019 in Wuhan city, China [1]
Administration of remdesivir to COVID-19 patients associates with better survival outcomes of Sharjah, United Arab Emirates (UAE); and by a Sandooq Al Watan Applied Research & Development grant to RH (SWARD-S20-007); by an Al Jalila Foundation (AJF202019) to RH; and by Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences (MRG/20/2020) to QH and RH; and by Prince Abdullah Ben Khalid Celiac Disease Research Chair, under the Vice Deanship of Research Chairs, King Saud University, Riyadh, Kingdom of Saudi Arabia
Administration of remdesivir within 7 days of symptom onset is associated with less need for mechanical ventilation and lower 28-days mortality
Summary
COVID-19, a respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2), was first identified in December 2019 in Wuhan city, China [1]. Dexamethasone has been shown to decrease mortality compared to placebo (25.7% in the placebo versus 22.9% in the dexamethasone cohort; P = 0.001), with the largest benefit seen among patients receiving mechanical ventilation support [2] Biologics, such as anti-interleukin (IL)-6 receptor monoclonal antibody, tocilizumab was used in combination to steroids, especially for the treatment of moderate to severe COVID-19 cases [3, 4]. Remdesivir, an inhibitor of viral RNA-dependent-RNA polymerase, was shown to have invitro inhibitory activity against SARS-CoV-1 [7], Middle East respiratory syndrome [8], and SARS-CoV-2 [9] It is the only WHO-approved antiviral treatment that has shown to reduce recovery time in severe COVID19 [4, 10,11,12], and it is the most widely used anti-SARS-CoV-2 treatment
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