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Real-world effectiveness and factors associated with increased mortality in non-critically ill patients with COVID-19 pneumonia receiving remdesivir
  1. Lucía Quesada Muñoz1,
  2. Jorge Fernández-Fradejas1,
  3. Hilario Martinez-Barros1,
  4. Marina Sánchez Cuervo1,
  5. Miriam Martín Rufo1,
  6. Maria del Rosario Pintor Recuenco1,
  7. Carmen Quereda Rodríguez-Navarro2,
  8. Ana María Álvarez-Díaz1,
  9. Javier Saez de la Fuente1
  1. 1Pharmacy, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
  2. 2Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
  1. Correspondence to Hilario Martinez-Barros, Pharmacy, Hospital Universitario Ramón y Cajal, Madrid, Spain; hilario.martinez{at}salud.madrid.org

Abstract

Objectives Evidence on the effectiveness of remdesivir when used in real-life clinical practice is controversial. This study aims to analyse its effectiveness and the factors associated with increased mortality in non-critically ill patients with COVID-19 pneumonia who require supplemental low-flow oxygen and received remdesivir.

Methods A retrospective cohort study was conducted at Ramón y Cajal University Hospital (Madrid, Spain) which included all patients treated with remdesivir in our institution during the second pandemic breakout in Spain, from August to November 2020. Treatment with remdesivir was limited to non-critically ill patients with COVID-19 pneumonia requiring low-flow supplemental oxygen, with a treatment duration of 5 days.

Results A total of 1757 patients were admitted with COVID-19 pneumonia during the study period, of which 281 non-critically ill patients were treated with remdesivir and included in the analysis. Mortality at 28 days after initiation of treatment was 17.1%. The median (IQR) time to recovery was 9 days (6–15). 104 (37.0%) patients had complications during hospitalisation, with renal failure being the most frequent (31 patients; 36.5%). After adjustment for confounding factors, high-flow oxygen therapy was associated with increased 28-day mortality (HR 2.77; 95% CI 1.39 to 5.53; p=0.004) and decreased 28-day clinical improvement (HR 0.54; 95% CI 0.35 to 0.85; p=0.008). A significant difference in survival and clinical improvement was identified between patients treated with high and low-flow oxygen.

Conclusion The 28-day mortality rate in patients treated with remdesivir needing low-flow oxygen therapy was higher than that published in clinical trials. Age and increased oxygen therapy needed after the beginning of treatment were the main risk factors associated with mortality.

  • COVID-19
  • Communicable Diseases
  • PULMONARY MEDICINE
  • VIROLOGY
  • DRUG-RELATED SIDE EFFECTS AND ADVERSE REACTIONS

Data availability statement

Data are available upon reasonable request.

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