Remdesivir plus dexamethasone is associated to improve the clinical outcome of COVID-19 hospitalized patients regardless of their vaccination status

INTRODUCTION: Remdesivir seems to reduce the risk of hospitalization and improve clinical outcome in hospitalized patients with COVID-19. OBJECTIVES: To compare the clinical outcome of COVID-19 hospitalized patients treated with remdesivir plus dexamethasone versus dexamethasone alone, according to their vaccination status. MATERIAL AND METHODS: A retrospective observational study was carried out in 165 patients hospitalized for COVID-19 from October 2021 to January 2022. Multivariate logistic regression, Kaplan–Meier and the log-rank tests were used to evaluate the event (need for ventilation or death). RESULTS: Patients treated with remdesivir plus dexamethasone (n = 87) compared with dexamethasone alone (n = 78) showed similar age (60 ± 16, 47–70 vs. 62 ± 37, 51–74 years) and number of comorbidities: 1 (0–2) versus 1.5 (1–3). Among 73 fully vaccinated patients, 42 (47.1%) were in remdesivir plus dexamethasone and 31 (41%) in dexamethasone alone. Patients treated with remdesivir plus dexamethasone needed intensive care less frequently (17.2% vs. 31%; p = 0.002), high-flow oxygen (25.3% vs. 50.0%; p = 0.002) and non-invasive mechanical ventilation (16.1% vs. 47.4%; p < 0.001). Furthermore, they had less complications during hospitalization (31.0% vs. 52.6%; p = 0.008), need of antibiotics (32.2% vs. 59%; p = 0.001) and radiologic worsening (21.8% vs. 44.9%; p = 0.005). Treatment with remdesivir plus dexamethasone (aHR, 0.26; 95% CI: 0.14–0.48; p < 0.001) and vaccination (aHR 0.39; 95% CI: 0.21–0.74) were independent factors associated with lower progression to mechanical ventilation or death. CONCLUSIONS: Remdesivir in combination with dexamethasone and vaccination independently and synergistically protects hospitalized COVID-19 patients requiring oxygen therapy from progression to severe disease or dead.