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Journal Article Research Support, Non-U.S. Gov't Ppublish 16 citations

PubMed: 39405443 DOI: 10.1093/cid/ciae510

Remdesivir-Associated Survival Outcomes Among Immunocompromised Patients Hospitalized for COVID-19: Real-world Evidence From the Omicron-Dominant Era.

Clin Infect Dis 79(Suppl 4):S149-S159

Authors: Essy Mozaffari, Aastha Chandak, Robert L Gottlieb, Chidinma Chima-Melton, Mark Berry, Alpesh N Amin, Paul E Sax, Andre C Kalil

Affiliations

  • Medical Affairs, Gilead Sciences, Foster City, California, USA.
  • Evidence and Access, Certara, New York, New York, USA.
  • Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA.
  • Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas, USA.
  • Baylor Scott & White The Heart Hospital, Plano, Texas, USA.
  • Baylor Scott & White Research Institute, Dallas, Texas, USA.
  • Pulmonary Division, Tele-ICU, Los Angeles, California, USA.
  • Department of Medicine, School of Medicine, University of California Irvine, Irvine, California, USA.
  • Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA.
  • Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.

Abstract

BACKGROUND

Patients with immunocompromising conditions are at increased risk for coronavirus disease 2019 (COVID-19)-related hospitalizations and deaths. Randomized clinical trials provide limited enrollment, if any, to provide information on the outcomes in such patients treated with remdesivir.

METHODS

Using the US PINC AI Healthcare Database, we identified adult patients with immunocompromising conditions, hospitalized for COVID-19 between December 2021 and February 2024. The primary outcome was all-cause inpatient mortality examined in propensity score-matched patients in remdesivir vs nonremdesivir groups. Subgroup analyses were performed for patients with cancer, hematological malignancies, and solid organ or hematopoietic stem cell transplant recipients.

RESULTS

Of 28 966 patients included in the study, 16 730 (58%) received remdesivir during the first 2 days of hospitalization. After propensity score matching, 8822 patients in the remdesivir and 8822 patients in the nonremdesivir group were analyzed. Remdesivir was associated with a significantly lower mortality rate among patients with no supplemental oxygen (adjusted hazard ratio [95% confidence interval], 0.73 [.62-.86] at 14 days and 0.79 [.68-.91] at 28 days) and among those with supplemental oxygen (0.75 [.67-.85] and 0.78 [.70-.86], respectively). Remdesivir was also associated with lower mortality rates in subgroups of patients with cancer, hematological malignancies (leukemia, lymphoma, or multiple myeloma), and solid organ or hematopoietic stem cell transplants.

CONCLUSIONS

In this large cohort of patients with immunocompromising conditions hospitalized for COVID-19, remdesivir was associated with significant improvement in survival, including patients with varied underlying immunocompromising conditions. The integration of current real-world evidence into clinical guideline recommendations can inform clinical communities to optimize treatment decisions in the evolving COVID-19 era, extending beyond the conclusion of the public health emergency declaration.

MeSH

Cells, Comorbidity, Mortality, Hospitalization, Microscopy, Electron, Scanning Transmission, Hematologic Neoplasms, Lymphoma, Neoplasms, Data Science, Propensity Score, Leukemia, Stem Cells, Multiple Myeloma, Covid-19, Immunocompromised Host, Transplants, Communicable Diseases, Hematopoietic Stem Cells, Transplantation

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