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Remdesivir treatment and clinical outcome in non-severe hospitalized COVID-19 patients: a propensity score matching multicenter Italian hospital experience

INTRODUCTION: Remdesivir exerts positive effects on clinical improvement, even though it seems not to affect mortality among COVID-19 patients; moreover, it was associated with the occurence of marked bradycardia. METHODS: We retrospectively evaluated 989 consecutive patients with non-severe COVID-1...

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Autores principales: Attena, Emilio, Caturano, Alfredo, Annunziata, Anna, Maraolo, Alberto Enrico, De Rosa, Annunziata, Fusco, Francesco Maria, Halasz, Geza, Dall’Ospedale, Valeria, Conte, Maddalena, Parisi, Valentina, Galiero, Raffaele, Sasso, Ferdinando Carlo, Fiorentino, Giuseppe, Russo, Vincenzo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10201037/
https://www.ncbi.nlm.nih.gov/pubmed/37212843
http://dx.doi.org/10.1007/s00228-023-03499-z
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author Attena, Emilio
Caturano, Alfredo
Annunziata, Anna
Maraolo, Alberto Enrico
De Rosa, Annunziata
Fusco, Francesco Maria
Halasz, Geza
Dall’Ospedale, Valeria
Conte, Maddalena
Parisi, Valentina
Galiero, Raffaele
Sasso, Ferdinando Carlo
Fiorentino, Giuseppe
Russo, Vincenzo
author_facet Attena, Emilio
Caturano, Alfredo
Annunziata, Anna
Maraolo, Alberto Enrico
De Rosa, Annunziata
Fusco, Francesco Maria
Halasz, Geza
Dall’Ospedale, Valeria
Conte, Maddalena
Parisi, Valentina
Galiero, Raffaele
Sasso, Ferdinando Carlo
Fiorentino, Giuseppe
Russo, Vincenzo
author_sort Attena, Emilio
collection PubMed
description INTRODUCTION: Remdesivir exerts positive effects on clinical improvement, even though it seems not to affect mortality among COVID-19 patients; moreover, it was associated with the occurence of marked bradycardia. METHODS: We retrospectively evaluated 989 consecutive patients with non-severe COVID-19 (SpO(2) ≥ 94% on room air) admitted from October 2020 to July 2021 at five Italian hospitals. Propensity score matching allowed to obtain a comparable control group. Primary endpoints were bradycardia onset (heart rate < 50 bpm), acute respiratory distress syndrome (ARDS) in need of intubation and mortality. RESULTS: A total of 200 patients (20.2%) received remdesivir, while 789 standard of care (79.8%). In the matched cohorts, severe ARDS in need of intubation was experienced by 70 patients (17.5%), significantly higher in the control group (68% vs. 31%; p < 0.0001). Conversely, bradycardia, experienced by 53 patients (12%), was significantly higher in the remdesivir subgroup (20% vs. 1.1%; p < 0.0001). During follow-up, all-cause mortality was 15% (N = 62), significantly higher in the control group (76% vs. 24%; log-rank p < 0.0001), as shown at the Kaplan–Meier (KM) analysis. KM furthermore showed a significantly higher risk of severe ARDS in need of intubation among controls (log-rank p < 0.001), while an increased risk of bradycardia onset in the remdesivir group (log-rank p < 0.001). Multivariable logistic regression showed a protective role of remdesivir for both ARDS in need of intubation (OR 0.50, 95%CI 0.29–0.85; p = 0.01) and mortality (OR 0.18, 95%CI 0.09–0.39; p < 0.0001). CONCLUSIONS: Remdesivir treatment emerged as associated with reduced risk of severe acute respiratory distress syndrome in need of intubation and mortality. Remdesivir-induced bradycardia was not associated with worse outcome.
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spelling pubmed-102010372023-05-23 Remdesivir treatment and clinical outcome in non-severe hospitalized COVID-19 patients: a propensity score matching multicenter Italian hospital experience Attena, Emilio Caturano, Alfredo Annunziata, Anna Maraolo, Alberto Enrico De Rosa, Annunziata Fusco, Francesco Maria Halasz, Geza Dall’Ospedale, Valeria Conte, Maddalena Parisi, Valentina Galiero, Raffaele Sasso, Ferdinando Carlo Fiorentino, Giuseppe Russo, Vincenzo Eur J Clin Pharmacol Research INTRODUCTION: Remdesivir exerts positive effects on clinical improvement, even though it seems not to affect mortality among COVID-19 patients; moreover, it was associated with the occurence of marked bradycardia. METHODS: We retrospectively evaluated 989 consecutive patients with non-severe COVID-19 (SpO(2) ≥ 94% on room air) admitted from October 2020 to July 2021 at five Italian hospitals. Propensity score matching allowed to obtain a comparable control group. Primary endpoints were bradycardia onset (heart rate < 50 bpm), acute respiratory distress syndrome (ARDS) in need of intubation and mortality. RESULTS: A total of 200 patients (20.2%) received remdesivir, while 789 standard of care (79.8%). In the matched cohorts, severe ARDS in need of intubation was experienced by 70 patients (17.5%), significantly higher in the control group (68% vs. 31%; p < 0.0001). Conversely, bradycardia, experienced by 53 patients (12%), was significantly higher in the remdesivir subgroup (20% vs. 1.1%; p < 0.0001). During follow-up, all-cause mortality was 15% (N = 62), significantly higher in the control group (76% vs. 24%; log-rank p < 0.0001), as shown at the Kaplan–Meier (KM) analysis. KM furthermore showed a significantly higher risk of severe ARDS in need of intubation among controls (log-rank p < 0.001), while an increased risk of bradycardia onset in the remdesivir group (log-rank p < 0.001). Multivariable logistic regression showed a protective role of remdesivir for both ARDS in need of intubation (OR 0.50, 95%CI 0.29–0.85; p = 0.01) and mortality (OR 0.18, 95%CI 0.09–0.39; p < 0.0001). CONCLUSIONS: Remdesivir treatment emerged as associated with reduced risk of severe acute respiratory distress syndrome in need of intubation and mortality. Remdesivir-induced bradycardia was not associated with worse outcome. Springer Berlin Heidelberg 2023-05-22 2023 /pmc/articles/PMC10201037/ /pubmed/37212843 http://dx.doi.org/10.1007/s00228-023-03499-z Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research
Attena, Emilio
Caturano, Alfredo
Annunziata, Anna
Maraolo, Alberto Enrico
De Rosa, Annunziata
Fusco, Francesco Maria
Halasz, Geza
Dall’Ospedale, Valeria
Conte, Maddalena
Parisi, Valentina
Galiero, Raffaele
Sasso, Ferdinando Carlo
Fiorentino, Giuseppe
Russo, Vincenzo
Remdesivir treatment and clinical outcome in non-severe hospitalized COVID-19 patients: a propensity score matching multicenter Italian hospital experience
title Remdesivir treatment and clinical outcome in non-severe hospitalized COVID-19 patients: a propensity score matching multicenter Italian hospital experience
title_full Remdesivir treatment and clinical outcome in non-severe hospitalized COVID-19 patients: a propensity score matching multicenter Italian hospital experience
title_fullStr Remdesivir treatment and clinical outcome in non-severe hospitalized COVID-19 patients: a propensity score matching multicenter Italian hospital experience
title_full_unstemmed Remdesivir treatment and clinical outcome in non-severe hospitalized COVID-19 patients: a propensity score matching multicenter Italian hospital experience
title_short Remdesivir treatment and clinical outcome in non-severe hospitalized COVID-19 patients: a propensity score matching multicenter Italian hospital experience
title_sort remdesivir treatment and clinical outcome in non-severe hospitalized covid-19 patients: a propensity score matching multicenter italian hospital experience
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10201037/
https://www.ncbi.nlm.nih.gov/pubmed/37212843
http://dx.doi.org/10.1007/s00228-023-03499-z
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