Remdesivir Plus Dexamethasone Versus Dexamethasone Alone for the Treatment of Coronavirus Disease 2019 (COVID-19) Patients Requiring Supplemental O2 Therapy: A Prospective Controlled Nonrandomized Study. (27th January 2022)

• Record Type: Journal Article
• Authors: Marrone, Aldo; Nevola, Riccardo; Sellitto, Ausilia; Cozzolino, Domenico; Romano, Ciro; Cuomo, Giovanna; Aprea, Concetta; Schwartzbaum, Michelangelo X Palou; Ricozzi, Carmen; Imbriani, Simona; Rinaldi, Luca; Gjeloshi, Klodian; Padula, Andrea; Ranieri, Roberta; Ruosi, Carolina; Meo, Luciana Agnese; Abitabile, Marianna; Cinone, Francesca; Carusone, Caterina; Adinolfi, Luigi Elio
• Is Part Of: Clinical infectious diseases. Volume 75:Number 1(2022)
• Page Start: e403
• Page End: e409
• Publication Date: 2022-01-27
• Subjects: COVID-19 -- remdesivir -- dexamethasone -- survival -- viral clearance; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciac014
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Remdesivir is an antiviral used to treat coronavirus disease 2019 (COVID-19), which improves some clinical outcomes. Dexamethasone has been shown to be effective in reducing mortality. It has been hypothesized that combination of these two drugs can improve mortality. We evaluated the effect of combination on mortality of COVID-19 patients requiring O2 therapy. Methods: A prospective quasi-experimental study, including two independent, sequential controlled cohorts, one received remdesivir-dexamethasone and the other dexamethasone alone, was designed. All COVID-19 patients requiring supplemental O2 therapy were enrolled consecutively. The sample size to power mortality was a priori calculated. The primary endpoints were 30-day mortality and viral clearance differences. Secondary endpoints were differences in hospitalization times, improvement in respiratory failure (PO2 /FiO2 ) and inflammatory indices (fibrinogen, CRP, neutrophil/lymphocyte ratio, D-Dimer). Kaplan-Meier curves and the log-rank test were used to evaluate significant differences in mortality between groups. Results: In total, 151 COVID-19 patients were enrolled (remdesivir/dexamethasone group, 76, and dexamethasone alone, 75). No differences in demographic, clinical, and laboratory characteristics were observed between the 2 groups at baseline. Faster viral clearance occurred in the remdesivir/dexamethasone group compared to dexamethasone alone (median 6 vs 16 days; P < .001). The 30-day mortality in the remdesivir/dexamethasone group was 1.3%, whereas in dexamethasone alone was 16% ( P < .005). In the remdesivir/dexamethasone group compared to dexamethasone alone there was a reduction in hospitalization days ( P < .0001) and a faster improvement in both respiratory function and inflammatory markers. Conclusions: Remdesivir/dexamethasone treatment is associated with significant reduction in mortality, length of hospitalization, and faster SARS-CoV-2 clearance, compared to dexamethasone alone. Abstract : Treatmentwith remdesevir plus dexamethasone in coronavirus disease 2019 (COVID-19) patients requiring supplemental O2 therapy compared to dexamethasone alone showed higher 30-day survival, faster viral clearance, shorter length of hospital stay, and faster reduction of inflammatory markers and improvement of respiratory function.