Remdesivir Use in Patients Requiring Mechanical Ventilation due to COVID-19. (13th October 2020)

• Record Type: Journal Article
• Authors: Lapadula, Giuseppe; Bernasconi, Davide Paolo; Bellani, Giacomo; Soria, Alessandro; Rona, Roberto; Bombino, Michela; Avalli, Leonello; Rondelli, Egle; Cortinovis, Barbara; Colombo, Enrico; Valsecchi, Maria Grazia; Migliorino, Guglielmo Marco; Bonfanti, Paolo; Foti, Giuseppe
• Is Part Of: Open forum infectious diseases. Volume 7:Number 11(2020)
• Publication Date: 2020-10-13
• Subjects: antiviral treatment -- coronavirus -- COVID-19 -- critically ill patients -- intensive care unit -- remdesivir -- SARS-CoV-2; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofaa481
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Remdesivir has been associated with accelerated recovery of severe coronavirus disease 2019 (COVID-19). However, whether it is also beneficial in patients requiring mechanical ventilation is uncertain. Methods: All consecutive intensive care unit (ICU) patients requiring mechanical ventilation due to COVID-19 were enrolled. Univariate and multivariable Cox models were used to explore the possible association between in-hospital death or hospital discharge, considered competing-risk events, and baseline or treatment-related factors, including the use of remdesivir. The rate of extubation and the number of ventilator-free days were also calculated and compared between treatment groups. Results: One hundred thirteen patients requiring mechanical ventilation were observed for a median of 31 days of follow-up; 32% died, 69% were extubated, and 66% were discharged alive from the hospital. Among 33 treated with remdesivir (RDV), lower mortality (15.2% vs 38.8%) and higher rates of extubation (88% vs 60%), ventilator-free days (median [interquartile range], 11 [0–16] vs 5 [0–14.5]), and hospital discharge (85% vs 59%) were observed. Using multivariable analysis, RDV was significantly associated with hospital discharge (hazard ratio [HR], 2.25; 95% CI, 1.27–3.97; P = .005) and with a nonsignificantly lower mortality (HR, 0.73; 95% CI, 0.26–2.1; P = .560). RDV was also independently associated with extubation (HR, 2.10; 95% CI, 1.19–3.73; P = .011), which was considered a competing risk to death in the ICU in an additional survival model. Conclusions: In our cohort of mechanically ventilated patients, RDV was not associated with a significant reduction of mortality, but it was consistently associated with shorter duration of mechanical ventilation and higher probability of hospital discharge, independent of other risk factors.