JAMA Netw Open Published online 15 July, 2021 | https://jamanetwork.com/journals/jamacardiology/fullarticle/2781601
Digest author(s): Stylianos Loukides, e-Learning Director / 25 July, 2021
Remdesivir has been widely used as a first line treatment for patients hospitalised due to COVID -19 infection. In the current study published in the medical journal JAMA its effectiveness is questioned, both in terms of its effect on survival (which has not been proven anyway), but also in terms of the effect on the shortening of hospitalisation.
This retrospective cohort study used data from the Veterans Health Administration (VHA) from 123 hospitals, and evaluated patients treated with confirmed COVID-19 from 1 May to 8 October 2020.
The primary endpoint of the study was death within 30 days of starting treatment with remdesivir (or the corresponding day of hospitalisation for the respective subjects in the control group) and time of hospital discharge.
The initial group included 5,898 patients, 2,374 (40.3%) of whom they were treated with remdesivir (2,238 men [94.3%] with an average age of 67.8 years) and 3,524 (59.7%) who was never treated with remdesivir (3,302 men [93.7%] with an average age of 67 years). After matching the calibration of the clinical condition, the analysis included 1,172 patients receiving remdesivir and 1,172 controls (individuals in the control group who did not receive the drug). Patients receiving remdesivir and the control group had similar age characteristics (average age 66.6 years vs. 67.5 years), sex (1,101 men [93.9%] in both groups), dexamethasone use (559 [47.7%] in both groups), hospitalisation in an intensive care unit (242 [20.7%] vs. 234 [19.1%]) and use of mechanical ventilation (intubation) (69 [5.9%] vs. 45 [3.8%]). Treatment with remdesivir was not associated with mortality risk at 30 days (143 remdesivir [12.2%] versus 124 in the control group [10.6%], with a relative risk ratio of 1.06).
The results were similar for those who received dexamethasone compared to those who did not receive dexamethasone at the start of remdesivir therapy. However, patients receiving remdesivir had a longer median time to leave the hospital compared to their respective controls (6 days versus 3 days) and this difference was statistically significant. Therefore, in this cohort study in hospitalised veterans with COVID-19 in the U.S., treatment with remdesivir was not associated with improved survival. Furthermore, treatment with remdesivir was associated with prolonged hospital stay. Considering the above result, the authors speculate that the above difference regarding hospital stay may be due to the fact that clinicians will not discharge patients who otherwise met the criteria for leaving the hospital until remdesivir administration is complete, as remdesivir is administered only intravenously.
The study has some limitations as the retrospective design, but at the same time raised a significant issue, which is the effectiveness of remdesivir in treating patients with COVID -19 infection. ERS guidelines do not support the use of remdesivir, while previous published data clearly supported the beneficial effect of remdesivir in terms of hospital stay. Which is the truth? The real truth is that COVID-19 infection is lacking an ideal treatment. We still have to push our efforts in order to define the right patient for the right treatment.