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Diaz GA, Christensen AB, Pusch T, Goulet D, Chang SC, Grunkemeier GL, McKelvey PA, Robicsek A, French T, Parsons GT, Doherty G, Laurenson C, Roper R, Hadlock J, Cover CJ, Footer B, Robinson P, Micikas M, Marfori JE, Cronenweth C, Mukkamala Y, Mackiewicz J, Rai E, Matson MD, Davila J, Rueda J, Tipton R, Algren H, Ward BC, Malkoski S, Gluckman T, Tallman GB, Arguinchona H, Hammond TC, Standaert S, Christensen J, Echaiz JF, Choi R, McClung D, Pacifico A, Fee M, Sarafian F, Berrington WR, Goldman JD. Remdesivir and Mortality in Patients with COVID-19. Clin Infect Dis 2021; 74:1812-1820. [PMID: 34409431 PMCID: PMC9155603 DOI: 10.1093/cid/ciab698] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Indexed: 12/21/2022] Open
Abstract
Background The impact of remdesivir (RDV) on mortality rates in coronavirus disease 2019 (COVID-19) is controversial, and the mortality effect in subgroups of baseline disease severity has been incompletely explored. The purpose of this study was to assess the association of RDV with mortality rates in patients with COVID-19. Methods In this retrospective cohort study we compared persons receiving RDV with those receiving best supportive care (BSC). Patients hospitalized between 28 February and 28 May 2020 with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection were included with the development of COVID-19 pneumonia on chest radiography and hypoxia requiring supplemental oxygen or oxygen saturation ≤94% with room air. The primary outcome was overall survival, assessed with time-dependent Cox proportional hazards regression and multivariable adjustment, including calendar time, baseline patient characteristics, corticosteroid use, and random effects for hospital. Results A total of 1138 patients were enrolled, including 286 who received RDV and 852 treated with BSC, 400 of whom received hydroxychloroquine. Corticosteroids were used in 20.4% of the cohort (12.6% in RDV and 23% in BSC). Comparing persons receiving RDV with those receiving BSC, the hazard ratio (95% confidence interval) for death was 0.46 (.31–.69) in the univariate model (P < .001) and 0.60 (.40–.90) in the risk-adjusted model (P = .01). In the subgroup of persons with baseline use of low-flow oxygen, the hazard ratio (95% confidence interval) for death in RDV compared with BSC was 0.63 (.39–1.00; P = .049). Conclusion Treatment with RDV was associated with lower mortality rates than BSC. These findings remain the same in the subgroup with baseline use of low-flow oxygen.
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Affiliation(s)
- George A Diaz
- Division of Medicine, Section of Infectious Diseases, Providence Regional Medical Center Everett, Everett, WA, USA.,Washington State University Elson S. Floyd College of Medicine, Internal Medicine Residency, Spokane, WA, USA
| | - Alyssa B Christensen
- Department of Pharmacy, Providence Oregon Region Shared Services, Portland, OR, USA
| | - Tobias Pusch
- Department of Internal Medicine, Section of Infectious Diseases, Providence St. Vincent Medical Center, Portland, OR, USA
| | - Delaney Goulet
- Washington State University Elson S. Floyd College of Medicine, Internal Medicine Residency, Spokane, WA, USA.,Division of Medicine, Section of Internal Medicine, Providence Regional Medical Center Everett, Everett, WA, USA
| | - Shu-Ching Chang
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence St. Joseph Health, Portland, Oregon, USA
| | - Gary L Grunkemeier
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence St. Joseph Health, Portland, Oregon, USA
| | - Paul A McKelvey
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence St. Joseph Health, Portland, Oregon, USA
| | - Ari Robicsek
- Department of Clinical Analytics, Providence St. Joseph Health, Renton, WA, USA
| | - Tom French
- Department of Clinical Analytics, Providence St. Joseph Health, Renton, WA, USA
| | - Guilford T Parsons
- Department of Clinical Analytics, Providence St. Joseph Health, Renton, WA, USA
| | - Glenn Doherty
- Department of Clinical Analytics, Providence St. Joseph Health, Renton, WA, USA
| | - Charles Laurenson
- Department of Clinical Analytics, Providence St. Joseph Health, Renton, WA, USA
| | - Ryan Roper
- Institute for Systems Biology, Seattle, WA, USA
| | | | - Cameron J Cover
- Department of Internal Medicine, Section of Infectious Diseases, Providence St. Vincent Medical Center, Portland, OR, USA
| | - Brent Footer
- Department of Pharmacy, Providence Oregon Region Shared Services, Portland, OR, USA
| | - Philip Robinson
- Department of Hospital Medicine, Division of Infectious Diseases, Hoag Memorial Hospital Presbyterian, Newport Beach, CA USA
| | - Mary Micikas
- Division of Infectious Diseases, Swedish Medical Center, Seattle, WA, USA.,Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, WA, USA
| | - Jennifer E Marfori
- Department of Internal Medicine, Section of Infectious Diseases, Providence St. Vincent Medical Center, Portland, OR, USA
| | - Charlotte Cronenweth
- Washington State University Elson S. Floyd College of Medicine, Internal Medicine Residency, Spokane, WA, USA
| | - Yogavedya Mukkamala
- Washington State University Elson S. Floyd College of Medicine, Internal Medicine Residency, Spokane, WA, USA
| | - Jamie Mackiewicz
- Washington State University Elson S. Floyd College of Medicine, Internal Medicine Residency, Spokane, WA, USA
| | - Ekra Rai
- Washington State University Elson S. Floyd College of Medicine, Internal Medicine Residency, Spokane, WA, USA
| | - Martha Dickinson Matson
- Washington State University Elson S. Floyd College of Medicine, Internal Medicine Residency, Spokane, WA, USA
| | - Jodie Davila
- Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, WA, USA
| | - Justin Rueda
- Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, WA, USA
| | - Reda Tipton
- Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, WA, USA
| | - Heather Algren
- Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, WA, USA
| | - Brittney C Ward
- Department of Internal Medicine, Spokane Teaching Health Clinic, Spokane, WA, USA
| | - Stephen Malkoski
- Sound Critical Care, Sacred Heart Medical Center, Spokane, WA, USA
| | - Tyler Gluckman
- Department of Cardiology, Providence St. Vincent Medical Center, Portland, OR, USA
| | | | | | - Terese C Hammond
- John Wayne Cancer Institute and Cancer Clinic, Providence St Johns Health Center, Santa Monica, CA, USA
| | | | | | - Jose F Echaiz
- Infectious Diseases, Kadlec Regional Medical Center, Richland, WA, USA
| | - Robert Choi
- Division of Medicine, Section of Infectious Diseases, Providence Regional Medical Center Everett, Everett, WA, USA
| | - Daniel McClung
- Division of Medicine, Section of Infectious Diseases, Providence Regional Medical Center Everett, Everett, WA, USA
| | - Albert Pacifico
- Division of Medicine, Section of Infectious Diseases, Providence Regional Medical Center Everett, Everett, WA, USA
| | - Martin Fee
- Department of Hospital Medicine, Division of Infectious Diseases, Hoag Memorial Hospital Presbyterian, Newport Beach, CA USA
| | - Farjad Sarafian
- Department of Hospital Medicine, Division of Infectious Diseases, Hoag Memorial Hospital Presbyterian, Newport Beach, CA USA
| | - William R Berrington
- Division of Infectious Diseases, Swedish Medical Center, Seattle, WA, USA.,Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, WA, USA
| | - Jason D Goldman
- Division of Infectious Diseases, Swedish Medical Center, Seattle, WA, USA.,Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, WA, USA.,Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
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