Routine remdesivir treatment prolongs hospital stay, does not improve survival: JAMA
The finding of the study that Remdesivir Use prolongs Hospital Length of Stay is Paradox of a Clinical Trial vs Real-Life Use.
USA: Routine use of remdesivir in hospitalized COVID-19 patients is associated with longer hospital stays but not with improved survival, according to results from a cohort study of US veterans published in the JAMA Network Open.
Remdesivir is the only antiviral drug approved by the Food and Drug Administration (FDA) for the treatment of COVID-19. After receiving its Emergency Use Authorization (EUA) in May 20201, it received its full approval in October 2020, largely on the heels of the ACTT-1 trial.
Remdesivir (GS-5734) is a prodrug of an inhibitor of the SARS-CoV-2 RNA-dependent RNA polymerase and is one of the first drugs to be studied for COVID-19 treatment. Randomized controlled trials have produced conflicting results about the effects of remdesivir therapy on length of hospital stay and survival among COVID-19 patients.
To get some clarity on the above topic, Michael E. Ohl, Iowa City Veterans Affairs (VA) Health Care System, Iowa City, and colleagues aimed to examine associations between remdesivir treatment and survival and length of hospital stay among people hospitalized with COVID-19 in routine care settings in a retrospective cohort study.
For this purpose, the researchers used data from the Veterans Health Administration (VHA) to identify adult patients in 23 VHA hospitals who had a first hospitalization with laboratory-confirmed COVID-19 from May 1 to October 8, 2020. An analytic cohort was created using propensity score matching of patients initiating remdesivir treatment to control patients who had not initiated remdesivir treatment by the same hospital day.
The main outcomes were time to death within 30 days of remdesivir treatment initiation (or corresponding hospital day for matched control individuals) and time to hospital discharge with time to death as a competing event.
The initial cohort included 5898 patients admitted to 123 hospitals, 40.3% of whom received remdesivir treatment (2238 men [94.3%]; mean age, 67.8 years) and 3524 (59.7%) of whom never received remdesivir treatment (3302 men [93.7%]; mean age, 67.0 years).
The research yielded the following findings:
- After propensity score matching, the analysis included 1172 remdesivir recipients and 1172 controls, for a final matched cohort of 2344 individuals.
- Remdesivir recipients and matched controls were similar with regard to age (mean, 66.6 years vs 67.5 years), sex (93.9% vs 1101 men 93.9%), dexamethasone use (47.7% vs 47.7%), admission to the intensive care unit (20.7% vs 19.1%), and mechanical ventilation use (5.9% 3.8%).
- Standardized differences were less than 10% for all measures.
- Remdesivir treatment was not associated with 30-day mortality (12.2% remdesivir recipients vs 10.6%).
- Results were similar for people receiving vs not receiving dexamethasone at remdesivir initiation (dexamethasone recipients: adjusted HR, 0.93; nonrecipients: adjusted HR, 1.19).
- Remdesivir recipients had a longer median time to hospital discharge compared with matched controls (6 days vs 3 days).
Routine use of remdesivir may be associated with increased use of hospital beds while not being associated with improvements in survival, concluded the authors.
The finding of the study that Remdesivir Use prolongs Hospital Length of Stay is Paradox of a Clinical Trial vs Real-Life Use.
Dr Gio J. Baracco, from Division of Infectious Diseases, Miller School of Medicine, University of Miami, Miami, Florida has stated in his commentary that it "The real-life application of a drug promising to hasten discharge from the hospital as its primary beneficial outcome must include an assessment of how easy it is to do so and make it clear that once a patient reaches that point, they can discontinue the drug. The paradoxical findings in the study by Ohl et al. compared with the study used for its authorization illustrate this point very clearly."
Reference:
The study titled, "Association of Remdesivir Treatment With Survival and Length of Hospital Stay Among US Veterans Hospitalized With COVID-19," is published in JAMA Network Open.
DOI: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781959
