Early Use of Remdesivir and Risk of Disease Progression in Hospitalized Patients With Mild to Moderate COVID-19.
COVID-19
COVID-19 progression
SARS CoV-2
early treatment
remdesivir
Journal
Clinical therapeutics
ISSN: 1879-114X
Titre abrégé: Clin Ther
Pays: United States
ID NLM: 7706726
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
received:
20
10
2021
revised:
08
01
2022
accepted:
10
01
2022
pubmed:
6
2
2022
medline:
28
4
2022
entrez:
5
2
2022
Statut:
ppublish
Résumé
Preliminary data suggest that remdesivir may influence the course of COVID-19 according to the duration of pre-admission symptoms. We aim to evaluate whether early use of remdesivir is associated with a reduced COVID-19 progression in a homogeneous cohort of patients with mild to moderate COVID-19. This prospective, observational study included patients with COVID-19 pneumonia treated with remdesivir at the University Hospital of Pisa (Italy) from September 2020 to January 2021. According to national recommendations, remdesivir was prescribed in patients with pneumonia who required oxygen supplementation by nasal cannula or mask but without the need for high-flow nasal cannula, non-invasive or invasive mechanical ventilation and had symptoms from no more than 10 days. Patients who received early (≤5 days from onset of symptoms) versus late (>5 days from onset of symptoms) remdesivir were compared. The primary outcome was a composite of high-flow nasal cannula, non-invasive or invasive mechanical ventilation, or death. A multivariate logistic regression analysis was performed to identify factors independently associated with the composite endpoint. Among 312 consecutive patients with COVID-19 pneumonia who received remdesivir, 90 (28.8%) received early remdesivir, whereas 222 (71.2%) received late remdesivir. Twenty-nine patients (32.2%) in the early-remdesivir group versus 104 patients (46.8%) in the late-remdesivir group met the primary end point (P = 0.018). On multivariate analysis, a history of dyspnea at home (odds ratio = 2.53; 95% CI, 1.55-4.12; P < 0.001) was the strongest factor independently associated with the progression to severe COVID-19, whereas early-remdesivir use was a protective factor (odds ratio = 0.49; 95% CI, 0.27-0.87; P = 0.015). The delayed admission to the hospital was associated with a delayed administration of remdesivir. The early use of remdesivir (<5 days from symptoms onset) may reduce COVID-19 progression. The identification of patients who need early hospitalization and early remdesivir may provide clinical benefit in patients with COVID-19.
Identifiants
pubmed: 35120742
pii: S0149-2918(22)00012-1
doi: 10.1016/j.clinthera.2022.01.007
pmc: PMC8761549
pii:
doi:
Substances chimiques
remdesivir
3QKI37EEHE
Adenosine Monophosphate
415SHH325A
Alanine
OF5P57N2ZX
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
364-373Informations de copyright
Copyright © 2022 Elsevier Ltd. All rights reserved.
Références
Clin Infect Dis. 2022 Apr 28;74(8):1450-1458
pubmed: 34265054
Lancet. 2020 May 16;395(10236):1569-1578
pubmed: 32423584
J Antimicrob Chemother. 2021 Nov 12;76(12):3296-3302
pubmed: 34473275
N Engl J Med. 2022 Jan 27;386(4):305-315
pubmed: 34937145
N Engl J Med. 2021 Mar 4;384(9):795-807
pubmed: 33306283
Clin Microbiol Infect. 2021 Mar;27(3):389-395
pubmed: 33359375
Sci Adv. 2021 Jan 1;7(1):
pubmed: 33187978
N Engl J Med. 2020 Nov 5;383(19):1813-1826
pubmed: 32445440
N Engl J Med. 2021 Feb 25;384(8):693-704
pubmed: 32678530
N Engl J Med. 2021 Feb 11;384(6):497-511
pubmed: 33264556
JAMA. 2020 Sep 15;324(11):1048-1057
pubmed: 32821939
Lancet. 2021 May 01;397(10285):1637-1645
pubmed: 33933206
Open Forum Infect Dis. 2020 Nov 19;7(12):ofaa563
pubmed: 33365358
Clin Infect Dis. 2022 Aug 24;75(1):e450-e458
pubmed: 34596223
Infect Dis Ther. 2021 Dec;10(4):2479-2488
pubmed: 34435337