Clinical Improvement, Outcomes, Antiviral Activity, and Costs Associated With Early Treatment With Remdesivir for Patients With Coronavirus Disease 2019 (COVID-19)
Abstract Background Evidence remains inconclusive on any significant benefits of remdesivir in patients with mild-to-moderate COVID-19. This study explored the disease progression, various clinical outcomes, changes in viral load, and costs associated with early remdesivir treatment among COVID-19 p...
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| Veröffentlicht in: | Clinical infectious diseases 2022-04, Vol.74 (8), p.1450-1458 |
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| creator | Wong, Carlos K H Lau, Kristy T K Au, Ivan C H Xiong, Xi Lau, Eric H Y Cowling, Benjamin J |
| description | Abstract
Background
Evidence remains inconclusive on any significant benefits of remdesivir in patients with mild-to-moderate COVID-19. This study explored the disease progression, various clinical outcomes, changes in viral load, and costs associated with early remdesivir treatment among COVID-19 patients.
Methods
A territory-wide retrospective cohort of 10 419 patients with COVID-19 hospitalized from 21 January 2020 to 31 January 2021 in Hong Kong was identified. Early remdesivir users were matched with controls using propensity-score matching in a ratio ≤1:4. Study outcomes were time to clinical improvement of at least 1 point on WHO clinical progression scale, hospital discharge, recovery, viral clearance, low viral load, positive IgG antibody, in-hospital death, and composite outcomes of in-hospital death requiring invasive ventilation or intensive care.
Results
After multiple imputation and propensity-score matching, median follow-up was 14 days for both remdesivir (n = 352) and control (n = 1347) groups. Time to clinical improvement was significantly shorter in the remdesivir group than that of control (HR: 1.14; 95% CI: 1.01–1.29; P = .038), as well as for achieving low viral load (1.51; 1.24–1.83; P |
| doi_str_mv | 10.1093/cid/ciab631 |
| format | Article |
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Background
Evidence remains inconclusive on any significant benefits of remdesivir in patients with mild-to-moderate COVID-19. This study explored the disease progression, various clinical outcomes, changes in viral load, and costs associated with early remdesivir treatment among COVID-19 patients.
Methods
A territory-wide retrospective cohort of 10 419 patients with COVID-19 hospitalized from 21 January 2020 to 31 January 2021 in Hong Kong was identified. Early remdesivir users were matched with controls using propensity-score matching in a ratio ≤1:4. Study outcomes were time to clinical improvement of at least 1 point on WHO clinical progression scale, hospital discharge, recovery, viral clearance, low viral load, positive IgG antibody, in-hospital death, and composite outcomes of in-hospital death requiring invasive ventilation or intensive care.
Results
After multiple imputation and propensity-score matching, median follow-up was 14 days for both remdesivir (n = 352) and control (n = 1347) groups. Time to clinical improvement was significantly shorter in the remdesivir group than that of control (HR: 1.14; 95% CI: 1.01–1.29; P = .038), as well as for achieving low viral load (1.51; 1.24–1.83; P < .001) and positive IgG antibody (1.50; 1.31–1.70; P < .001). Early remdesivir treatment was associated with lower risk of in-hospital death (HR: .58; 95% CI: .34–.99; P = .045), in addition to a significantly shorter length of hospital stay (difference: −2.56 days; 95% CI: −4.86 to −.26; P = .029), without increasing risks of composite outcomes for clinical deterioration.
Conclusions
Early remdesivir treatment could be extended to hospitalized patients with moderate COVID-19 not requiring oxygen therapy on admission.
Among hospitalized patients with moderate COVID-19, early initiation of remdesivir was associated with significantly shorter time to clinical improvement, low viral load and positive IgG (immunoglobulin G) antibody, a shorter length of hospital stay, and a significantly lower risk of in-hospital death.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciab631</identifier><identifier>PMID: 34265054</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Adenosine Monophosphate - analogs & derivatives ; Alanine - analogs & derivatives ; Antiviral Agents ; COVID-19 - drug therapy ; Hospital Mortality ; Humans ; Immunoglobulin G ; Retrospective Studies ; SARS-CoV-2</subject><ispartof>Clinical infectious diseases, 2022-04, Vol.74 (8), p.1450-1458</ispartof><rights>The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. 2021</rights><rights>The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c357t-aea857fe0c10a42b7be491e233039528e1fac5f132d1f44c36c318392e85ccb43</citedby><cites>FETCH-LOGICAL-c357t-aea857fe0c10a42b7be491e233039528e1fac5f132d1f44c36c318392e85ccb43</cites><orcidid>0000-0002-6895-6071</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34265054$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wong, Carlos K H</creatorcontrib><creatorcontrib>Lau, Kristy T K</creatorcontrib><creatorcontrib>Au, Ivan C H</creatorcontrib><creatorcontrib>Xiong, Xi</creatorcontrib><creatorcontrib>Lau, Eric H Y</creatorcontrib><creatorcontrib>Cowling, Benjamin J</creatorcontrib><title>Clinical Improvement, Outcomes, Antiviral Activity, and Costs Associated With Early Treatment With Remdesivir for Patients With Coronavirus Disease 2019 (COVID-19)</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Abstract
Background
Evidence remains inconclusive on any significant benefits of remdesivir in patients with mild-to-moderate COVID-19. This study explored the disease progression, various clinical outcomes, changes in viral load, and costs associated with early remdesivir treatment among COVID-19 patients.
Methods
A territory-wide retrospective cohort of 10 419 patients with COVID-19 hospitalized from 21 January 2020 to 31 January 2021 in Hong Kong was identified. Early remdesivir users were matched with controls using propensity-score matching in a ratio ≤1:4. Study outcomes were time to clinical improvement of at least 1 point on WHO clinical progression scale, hospital discharge, recovery, viral clearance, low viral load, positive IgG antibody, in-hospital death, and composite outcomes of in-hospital death requiring invasive ventilation or intensive care.
Results
After multiple imputation and propensity-score matching, median follow-up was 14 days for both remdesivir (n = 352) and control (n = 1347) groups. Time to clinical improvement was significantly shorter in the remdesivir group than that of control (HR: 1.14; 95% CI: 1.01–1.29; P = .038), as well as for achieving low viral load (1.51; 1.24–1.83; P < .001) and positive IgG antibody (1.50; 1.31–1.70; P < .001). Early remdesivir treatment was associated with lower risk of in-hospital death (HR: .58; 95% CI: .34–.99; P = .045), in addition to a significantly shorter length of hospital stay (difference: −2.56 days; 95% CI: −4.86 to −.26; P = .029), without increasing risks of composite outcomes for clinical deterioration.
Conclusions
Early remdesivir treatment could be extended to hospitalized patients with moderate COVID-19 not requiring oxygen therapy on admission.
Among hospitalized patients with moderate COVID-19, early initiation of remdesivir was associated with significantly shorter time to clinical improvement, low viral load and positive IgG (immunoglobulin G) antibody, a shorter length of hospital stay, and a significantly lower risk of in-hospital death.</description><subject>Adenosine Monophosphate - analogs & derivatives</subject><subject>Alanine - analogs & derivatives</subject><subject>Antiviral Agents</subject><subject>COVID-19 - drug therapy</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Immunoglobulin G</subject><subject>Retrospective Studies</subject><subject>SARS-CoV-2</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1q3DAUhUVpaX5X2RetSkLHqX4sj7UcnLQdCEwIabI0snxNFGxrqisH5nn6otXgaZddCF10Pr4LOoRccHbNmZZfrWvTMU0h-TtyzJVcZoXS_H2amSqzvJTlETlBfGWM85Kpj-RI5qJQTOXH5HfVu9FZ09P1sA3-DQYY44Jupmj9ALigqzG6NxcSsLL7Ke4W1IwtrTxGpCtEn3ZHaOmziy_01oR-Rx8DmLgXzY8PMLSAewvtfKD3JrqU4RxWPvjRpGxCeuMQDAIVjGt6WW2e1jcZ11dn5ENneoTzw31Kfn67fax-ZHeb7-tqdZdZqZYxM2BKteyAWc5MLpplA7nmIKRkUitRAu-MVR2XouVdnltZWMlLqQWUytoml6fkcvamj_g1AcZ6cGih780IfsJaKCW0loVgCf0yozZ4xABdvQ1uMGFXc1bvW6lTK_WhlUR_OoinZoD2H_u3hgR8ngE_bf9r-gOqopZ4</recordid><startdate>20220428</startdate><enddate>20220428</enddate><creator>Wong, Carlos K H</creator><creator>Lau, Kristy T K</creator><creator>Au, Ivan C H</creator><creator>Xiong, Xi</creator><creator>Lau, Eric H Y</creator><creator>Cowling, Benjamin J</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6895-6071</orcidid></search><sort><creationdate>20220428</creationdate><title>Clinical Improvement, Outcomes, Antiviral Activity, and Costs Associated With Early Treatment With Remdesivir for Patients With Coronavirus Disease 2019 (COVID-19)</title><author>Wong, Carlos K H ; Lau, Kristy T K ; Au, Ivan C H ; Xiong, Xi ; Lau, Eric H Y ; Cowling, Benjamin J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c357t-aea857fe0c10a42b7be491e233039528e1fac5f132d1f44c36c318392e85ccb43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adenosine Monophosphate - analogs & derivatives</topic><topic>Alanine - analogs & derivatives</topic><topic>Antiviral Agents</topic><topic>COVID-19 - drug therapy</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Immunoglobulin G</topic><topic>Retrospective Studies</topic><topic>SARS-CoV-2</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wong, Carlos K H</creatorcontrib><creatorcontrib>Lau, Kristy T K</creatorcontrib><creatorcontrib>Au, Ivan C H</creatorcontrib><creatorcontrib>Xiong, Xi</creatorcontrib><creatorcontrib>Lau, Eric H Y</creatorcontrib><creatorcontrib>Cowling, Benjamin J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wong, Carlos K H</au><au>Lau, Kristy T K</au><au>Au, Ivan C H</au><au>Xiong, Xi</au><au>Lau, Eric H Y</au><au>Cowling, Benjamin J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical Improvement, Outcomes, Antiviral Activity, and Costs Associated With Early Treatment With Remdesivir for Patients With Coronavirus Disease 2019 (COVID-19)</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2022-04-28</date><risdate>2022</risdate><volume>74</volume><issue>8</issue><spage>1450</spage><epage>1458</epage><pages>1450-1458</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Abstract
Background
Evidence remains inconclusive on any significant benefits of remdesivir in patients with mild-to-moderate COVID-19. This study explored the disease progression, various clinical outcomes, changes in viral load, and costs associated with early remdesivir treatment among COVID-19 patients.
Methods
A territory-wide retrospective cohort of 10 419 patients with COVID-19 hospitalized from 21 January 2020 to 31 January 2021 in Hong Kong was identified. Early remdesivir users were matched with controls using propensity-score matching in a ratio ≤1:4. Study outcomes were time to clinical improvement of at least 1 point on WHO clinical progression scale, hospital discharge, recovery, viral clearance, low viral load, positive IgG antibody, in-hospital death, and composite outcomes of in-hospital death requiring invasive ventilation or intensive care.
Results
After multiple imputation and propensity-score matching, median follow-up was 14 days for both remdesivir (n = 352) and control (n = 1347) groups. Time to clinical improvement was significantly shorter in the remdesivir group than that of control (HR: 1.14; 95% CI: 1.01–1.29; P = .038), as well as for achieving low viral load (1.51; 1.24–1.83; P < .001) and positive IgG antibody (1.50; 1.31–1.70; P < .001). Early remdesivir treatment was associated with lower risk of in-hospital death (HR: .58; 95% CI: .34–.99; P = .045), in addition to a significantly shorter length of hospital stay (difference: −2.56 days; 95% CI: −4.86 to −.26; P = .029), without increasing risks of composite outcomes for clinical deterioration.
Conclusions
Early remdesivir treatment could be extended to hospitalized patients with moderate COVID-19 not requiring oxygen therapy on admission.
Among hospitalized patients with moderate COVID-19, early initiation of remdesivir was associated with significantly shorter time to clinical improvement, low viral load and positive IgG (immunoglobulin G) antibody, a shorter length of hospital stay, and a significantly lower risk of in-hospital death.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>34265054</pmid><doi>10.1093/cid/ciab631</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-6895-6071</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adenosine Monophosphate - analogs & derivatives Alanine - analogs & derivatives Antiviral Agents COVID-19 - drug therapy Hospital Mortality Humans Immunoglobulin G Retrospective Studies SARS-CoV-2 |
| title | Clinical Improvement, Outcomes, Antiviral Activity, and Costs Associated With Early Treatment With Remdesivir for Patients With Coronavirus Disease 2019 (COVID-19) |
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