Clinical outcomes by supplemental oxygen use in remdesivir-treated, hospitalised adults with COVID-19.

COVID-19 Mortality Outcome Remdesivir Supplemental oxygen

Journal

Infectious diseases now
ISSN: 2666-9919
Titre abrégé: Infect Dis Now
Pays: France
ID NLM: 101775152

Informations de publication

Date de publication:
Oct 2023
Historique:
received: 20 12 2022
accepted: 07 07 2023
pubmed: 17 7 2023
medline: 17 7 2023
entrez: 16 7 2023
Statut: ppublish

Résumé

Clinical trials show different effects of remdesivir on clinical outcomes relative to COVID-19 severity at hospital admission; in Europe, there are few real-world data. A multicentre, multinational retrospective cohort study in adult patients hospitalised with PCR-confirmed COVID-19 was conducted to understand remdesivir clinical use in different countries and to describe outcomes for patients receiving remdesivir stratified by oxygen use. Primary endpoints were all-cause mortality at day 28 and hospitalisation duration. Patients were categorised by baseline disease severity: no supplemental oxygen (NSO); low flow oxygen ≤ 6 litres (l)/minute (LFO); high flow oxygen > 6 l/minute (HFO). Four hundred and forty-eight (448) patients (72 [16.1%] HFO; 295 [65.8%] LFO; 81 (18.1%] NSO) were included; median age was 65 years and 64% were male. Mortality was higher in patients on HFO (rate 23.6%) compared to LFO (10.2%; p = 0.001) or NSO (6.2%; p = 0.002). Duration of hospitalisation was longer in patients on HFO (13 days) compared to LFO (9 days; p = 0.003) and NSO (9 days; p = 0.021). Patients who initiated remdesivir ≥ 2 days compared to within a day of hospitalisation had a 4.2 times higher risk of death, irrespective of age, sex, comorbidities, and oxygen support at baseline. Requirement for mechanical ventilation/ECMO and readmission within 28 days of discharge was similar across groups. Remdesivir use and outcomes differed by country. A higher mortality rate and duration of hospitalisation was seen in remdesivir-treated COVID-19 patients on HFO compared to LFO and NSO. Initiation of remdesivir upon admission as opposed to delayed initiation has a mortality benefit. NCT04847622.

Sections du résumé

BACKGROUND BACKGROUND
Clinical trials show different effects of remdesivir on clinical outcomes relative to COVID-19 severity at hospital admission; in Europe, there are few real-world data.
METHODS METHODS
A multicentre, multinational retrospective cohort study in adult patients hospitalised with PCR-confirmed COVID-19 was conducted to understand remdesivir clinical use in different countries and to describe outcomes for patients receiving remdesivir stratified by oxygen use. Primary endpoints were all-cause mortality at day 28 and hospitalisation duration. Patients were categorised by baseline disease severity: no supplemental oxygen (NSO); low flow oxygen ≤ 6 litres (l)/minute (LFO); high flow oxygen > 6 l/minute (HFO).
RESULTS RESULTS
Four hundred and forty-eight (448) patients (72 [16.1%] HFO; 295 [65.8%] LFO; 81 (18.1%] NSO) were included; median age was 65 years and 64% were male. Mortality was higher in patients on HFO (rate 23.6%) compared to LFO (10.2%; p = 0.001) or NSO (6.2%; p = 0.002). Duration of hospitalisation was longer in patients on HFO (13 days) compared to LFO (9 days; p = 0.003) and NSO (9 days; p = 0.021). Patients who initiated remdesivir ≥ 2 days compared to within a day of hospitalisation had a 4.2 times higher risk of death, irrespective of age, sex, comorbidities, and oxygen support at baseline. Requirement for mechanical ventilation/ECMO and readmission within 28 days of discharge was similar across groups. Remdesivir use and outcomes differed by country.
CONCLUSIONS CONCLUSIONS
A higher mortality rate and duration of hospitalisation was seen in remdesivir-treated COVID-19 patients on HFO compared to LFO and NSO. Initiation of remdesivir upon admission as opposed to delayed initiation has a mortality benefit.
CLINICAL TRIALS REGISTRATION BACKGROUND
NCT04847622.

Identifiants

DOI: 10.1016/j.idnow.2023.104760 PMID: 37454762
pubmed: 37454762
pii: S2666-9919(23)00122-7
doi: 10.1016/j.idnow.2023.104760
pii:
doi:

Banques de données

ClinicalTrials.gov
['NCT04847622']

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

104760

Informations de copyright

Copyright © 2023. Published by Elsevier Masson SAS.

Déclaration de conflit d'intérêts

Declaration of Competing Interest EM, RH, and PH are employees of Gilead Sciences Inc and own stock/stock options. CR received grants from ViiV, Gilead Sciences, Aidsfonds, Dutch Federation Medical Specialist, Erasmus MC, ZonMW, Health∼Holland. AC has received grants/research support, and honoraria or consultation fees from Gilead Sciences, Janssen, MSD, and ViiV. LM has received consultation fees from Gilead Sciences, Angelini and MSD. AS has received honoraria for lectures and advisory boards from Pfizer, MSD, Menarini, Shionogi, Angelini, Roche, and Gilead Sciences. AS has also received a grant from Pfizer and Gilead Sciences.

Auteurs

Nadir Arber (N)

Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel. Electronic address: nadira@tlvmc.gov.il.

Pallav L Shah (PL)

Royal Brompton Hospital, Sydney Street, SW3 6NP London, United Kingdom; Chelsea and Westminster Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Rd, Chelsea, London SW10 9NH, UK; National Heart and Lung Institute, Imperial College, Guy Scadding Building, Dovehouse St, London SW3 6LY, UK. Electronic address: pallav.shah@imperial.ac.uk.

Lambert Assoumou (L)

Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 15 Rue de l'École de Médecine, 75006 Paris, France. Electronic address: lambert.assoumou@iplesp.upmc.fr.

Casper Rokx (C)

Erasmus University Medical Center, Department of Internal Medicine and Department of Medical Microbiology and Infectious Diseases, Wytemaweg 80, 3015 CN Rotterdam, Netherlands. Electronic address: c.rokx@erasmusmc.nl.

Nathalie De Castro (N)

AP-HP Hôpital Saint-Louis, 1 Av. Claude Vellefaux, 75010 Paris, France. Electronic address: nathalie.de-castro@aphp.fr.

Ameet Bakhai (A)

Barnet Hospital, Royal Free London NHS Foundation Trust, Wellhouse Ln, Barnet, EN5 3DJ London, UK. Electronic address: asbakhai@nhs.net.

Alex Soriano Viladomiu (A)

Hospital Clinic de Barcelona, University of Barcelona, IDIBAPS, CIBERINF, C. de Villarroel, 170, 08036 Barcelona, Spain. Electronic address: viladomiu@me.com.

Lourdes Mateu (L)

Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain. Electronic address: lmateu.germanstrias@gencat.cat.

Carlos Lumbreras (C)

Hospital Universitario, 12 de Octubre, v. de Córdoba, s/n, 28041 Madrid, Spain. Electronic address: calumbre@ucm.es.

Vicente Estrada (V)

Hospital Clinico San Carlos-IdiSSC, Calle del Prof Martín Lagos, 28040 Madrid, Spain. Electronic address: vicente.estrada@salud.madrid.org.

Adrian Curran (A)

Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain. Electronic address: acurran@vhebron.net.

Pierre-Olivier Sellier (PO)

AP-HP Hôpital Lariboisière, 2, rue Ambroise Paré, 75475 Paris Cedex 10, France. Electronic address: pierre.sellier@aphp.fr.

Annie Duffy (A)

Research Organisation Kings Cross, The Stanley Building, 7 Pancras Square, N1C 4AG London, UK. Electronic address: Annie.Duffy@rokcservices.com.

Carl Fletcher (C)

Research Organisation Kings Cross, The Stanley Building, 7 Pancras Square, N1C 4AG London, UK. Electronic address: Carl.Fletcher@rokcservices.com.

Essy Mozaffari (E)

Gilead Sciences Inc, 333 Lakeside Dr, Foster City, CA 94404, United States. Electronic address: essy.mozaffari@gilead.com.

Richard Haubrich (R)

Gilead Sciences Inc, 333 Lakeside Dr, Foster City, CA 94404, United States. Electronic address: Richard.Haubrich@gilead.com.

Paul Hodgkins (P)

Gilead Sciences Inc, 333 Lakeside Dr, Foster City, CA 94404, United States. Electronic address: paul.hodgkins@gilead.com.

Anton Pozniak (A)

Chelsea and Westminster Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Rd, Chelsea, London SW10 9NH, UK. Electronic address: anton.pozniak@nhs.net.

Francois Raffi (F)

Centre Hospitalier Universitaire de Nantes and CIC 1413 INSERM, 1 Pl. Alexis-Ricordeau, 44093 Nantes, France. Electronic address: Francois.raffi@wanadoo.fr.

Classifications MeSH