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- Title
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
- 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.
- Subjects
EUROPE; COVID-19; CONFIDENCE intervals; MULTIPLE regression analysis; ANTIVIRAL agents; TREATMENT effectiveness; SURVEYS; DESCRIPTIVE statistics; RESEARCH funding; SOCIODEMOGRAPHIC factors; ODDS ratio; COMORBIDITY; COVID-19 pandemic
- Publication
Infection, 2023, Vol 51, Issue 4, p1033
- ISSN
0300-8126
- Publication type
Article
- DOI
10.1007/s15010-023-01994-0