COVID-19: remdesivir is linked to improved survival in critically ill patients

  • Pasquini Z & al.
  • J Antimicrob Chemother
  • 23 ago. 2020

  • de Miriam Davis, PhD
  • Clinical Essentials
El acceso al contenido completo es sólo para profesionales sanitarios registrados. El acceso al contenido completo es sólo para profesionales sanitarios registrados.

Takeaway

  • For patients with COVID-19 who were mechanically ventilated in the ICU, remdesivir, administered under compassionate use approval, was linked to improved survival in this cohort study.

Why this matters

  • This study examined the effect of remdesivir in the most severely ill patients with COVID-19, who received it under compassionate use approval.

Study design

  • Retrospective cohort study in an Italian ICU of patients treated with remdesivir (n=25) under compassionate use compared with patients who had not received the drug (n=26).
  • Remdesivir dose was 200 mg intravenously (IV) on day 1 of a 10-day course, followed by 100 mg IV for the remaining 9 days.
  • Funding: No external funds.

Key results

  • Median age of patients was 67 (interquartile range [IQR], 59-75.5) years; 92.2% were male.
  • Median follow-up, 52 (46-57) days.
  • Symptom onset was 10 (IQR, 8-12) days before ICU admission.
  • Overall mortality: 74.5%.
  • Mortality was lower with remdesivir (56%) vs without it (92.3%; P<.001>
  • Upon multivariate analysis, high comorbidity on the Charlson Comorbidity Index was the only factor associated with higher mortality (OR, 1.184; P=.020).
  • Receipt of remdesivir was the only factor associated with better survival (OR, 3.506; P<.001>

Limitations

  • Small numbers of patients in each group.
  • Lack of clinician blinding.
  • Nonrandomized design.
  • Single center.
  • Compassionate use of remdesivir likely introduced selection bias.
  • Observational; residual confounding likely.