The antiviral drug remdesivir (Veklury) improves the time to recovery of hospitalized COVID-19 patients, this according to a multi-center effectiveness study published in JAMA Network Open.
The retrospective study, conducted by Johns Hopkins University researchers, involved 2,299 COVID-19 patients receiving care in a 5-hospital health system in the Baltimore and Washington, DC, area from March to August 2020. About 15% percent received remdesivir (342) as part of their treatment, of which 285 were matched with controls.
Clinical improvement was defined as release from the hospital without worsening of World Health Administration (WHO) severity score during hospitalization or within 28 days after the start of remdesivir or maximum follow-up. Median time from hospitalization to treatment initiation was 1.1 days. Most patients in the remdesivir group (88.6%) were given 5 days of treatment.
5 vs. 7 days to improvement
Some people might think a difference of 2 days is not enough but when it comes to patients with illness serious enough to be hospitalized, 2 days can significantly change the course of the disease.
Of the 570 matched patients, 82.8% of those given remdesivir and 74.7% controls clinically improved after a median of 5 days and 7 days, respectively (adjusted hazard ratio [aHR], 1.47). Remdesivir recipients who breathed ambient air or received oxygen via nasal cannula reached clinical improvement after a median of 5 days, compared with 6 days in controls (aHR, 1.41). Likewise, severely ill patients needing more intense respiratory support achieved clinical improvement after a median of 8 days, versus 9 days in controls (aHR, 1.59). A little more than half (53.8%, 184) of those who received remdesivir also received corticosteroids, while the remaining 158 were given only remdesivir. The combination of remdesivir and corticosteroids was not linked to a decreased 28-day death rate (aHR, 1.94).
The US Food and Drug Administration (US FDA) approved remdesivir for treatment of hospitalized COVID-19 patients aged 12 and older on Oct 22, 2020, based largely on results from the Adaptive COVID-19 Treatment Trial, while the WHO recommended against its use, based on the results of the larger Solidarity Trial.
The authors concluded that their findings suggest that remdesivir was tied to a substantial reduction in the time to recovery among hospitalized COVID-19 patients. The results provide further evidence that remdesivir may be effective in reducing the duration of COVID-19 illness, that a 5-day treatment course may be sufficient.
Dr. Melvin Sanicas (@Vaccinologist) is a physician-scientist specializing in vaccines, infectious diseases, and global health.