Real-world effectiveness and factors associated with increased mortality in non-critically ill patients with COVID-19 pneumonia receiving remdesivir

Lucía Quesada Muñoz; Jorge Fernández-Fradejas; Hilario Martinez-Barros; Marina Sánchez Cuervo; Miriam Martín Rufo; Maria Del Rosario Pintor Recuenco; Carmen Quereda Rodríguez-Navarro; Ana María Álvarez-Díaz; Javier Saez de la Fuente

doi:10.1136/ejhpharm-2023-003729

Real-world effectiveness and factors associated with increased mortality in non-critically ill patients with COVID-19 pneumonia receiving remdesivir

Eur J Hosp Pharm. 2023 Jun 20:ejhpharm-2023-003729. doi: 10.1136/ejhpharm-2023-003729. Online ahead of print.

Authors

Lucía Quesada Muñoz¹, Jorge Fernández-Fradejas¹, Hilario Martinez-Barros², Marina Sánchez Cuervo¹, Miriam Martín Rufo¹, Maria Del Rosario Pintor Recuenco¹, Carmen Quereda Rodríguez-Navarro³, Ana María Álvarez-Díaz¹, Javier Saez de la Fuente¹

Affiliations

¹ Pharmacy, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
² Pharmacy, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain hilario.martinez@salud.madrid.org.
³ Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.

PMID: 37339865
DOI: 10.1136/ejhpharm-2023-003729

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.

Keywords: COVID-19; Communicable Diseases; DRUG-RELATED SIDE EFFECTS AND ADVERSE REACTIONS; PULMONARY MEDICINE; VIROLOGY.