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Early Use of Remdesivir and Risk of Disease Progression in Hospitalized Patients With Mild to Moderate COVID-19
PURPOSE: Preliminary data suggest that remdesivir may influence the course of COVID-19 according to the duration of pre-admission symptoms. We aim to evaluate whether early use of remdesivir is associated with a reduced COVID-19 progression in a homogeneous cohort of patients with mild to moderate C...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8761549/ https://www.ncbi.nlm.nih.gov/pubmed/35120742 http://dx.doi.org/10.1016/j.clinthera.2022.01.007 |
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author | Falcone, Marco Suardi, Lorenzo Roberto Tiseo, Giusy Barbieri, Chiara Giusti, Lisa Galfo, Valentina Forniti, Arianna Caroselli, Claudio Della Sala, Leonardo Tempini, Sara Okoye, Chukwuma Monzani, Fabio Menichetti, Francesco |
author_facet | Falcone, Marco Suardi, Lorenzo Roberto Tiseo, Giusy Barbieri, Chiara Giusti, Lisa Galfo, Valentina Forniti, Arianna Caroselli, Claudio Della Sala, Leonardo Tempini, Sara Okoye, Chukwuma Monzani, Fabio Menichetti, Francesco |
author_sort | Falcone, Marco |
collection | PubMed |
description | PURPOSE: Preliminary data suggest that remdesivir may influence the course of COVID-19 according to the duration of pre-admission symptoms. We aim to evaluate whether early use of remdesivir is associated with a reduced COVID-19 progression in a homogeneous cohort of patients with mild to moderate COVID-19. METHODS: This prospective, observational study included patients with COVID-19 pneumonia treated with remdesivir at the University Hospital of Pisa (Italy) from September 2020 to January 2021. According to national recommendations, remdesivir was prescribed in patients with pneumonia who required oxygen supplementation by nasal cannula or mask but without the need for high-flow nasal cannula, non-invasive or invasive mechanical ventilation and had symptoms from no more than 10 days. Patients who received early (≤5 days from onset of symptoms) versus late (>5 days from onset of symptoms) remdesivir were compared. The primary outcome was a composite of high-flow nasal cannula, non-invasive or invasive mechanical ventilation, or death. A multivariate logistic regression analysis was performed to identify factors independently associated with the composite endpoint. FINDINGS: Among 312 consecutive patients with COVID-19 pneumonia who received remdesivir, 90 (28.8%) received early remdesivir, whereas 222 (71.2%) received late remdesivir. Twenty-nine patients (32.2%) in the early-remdesivir group versus 104 patients (46.8%) in the late-remdesivir group met the primary end point (P = 0.018). On multivariate analysis, a history of dyspnea at home (odds ratio = 2.53; 95% CI, 1.55–4.12; P < 0.001) was the strongest factor independently associated with the progression to severe COVID-19, whereas early-remdesivir use was a protective factor (odds ratio = 0.49; 95% CI, 0.27–0.87; P = 0.015). The delayed admission to the hospital was associated with a delayed administration of remdesivir. IMPLICATIONS: The early use of remdesivir (<5 days from symptoms onset) may reduce COVID-19 progression. The identification of patients who need early hospitalization and early remdesivir may provide clinical benefit in patients with COVID-19. |
format | Online Article Text |
id | pubmed-8761549 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-87615492022-01-18 Early Use of Remdesivir and Risk of Disease Progression in Hospitalized Patients With Mild to Moderate COVID-19 Falcone, Marco Suardi, Lorenzo Roberto Tiseo, Giusy Barbieri, Chiara Giusti, Lisa Galfo, Valentina Forniti, Arianna Caroselli, Claudio Della Sala, Leonardo Tempini, Sara Okoye, Chukwuma Monzani, Fabio Menichetti, Francesco Clin Ther COVID Original Research PURPOSE: Preliminary data suggest that remdesivir may influence the course of COVID-19 according to the duration of pre-admission symptoms. We aim to evaluate whether early use of remdesivir is associated with a reduced COVID-19 progression in a homogeneous cohort of patients with mild to moderate COVID-19. METHODS: This prospective, observational study included patients with COVID-19 pneumonia treated with remdesivir at the University Hospital of Pisa (Italy) from September 2020 to January 2021. According to national recommendations, remdesivir was prescribed in patients with pneumonia who required oxygen supplementation by nasal cannula or mask but without the need for high-flow nasal cannula, non-invasive or invasive mechanical ventilation and had symptoms from no more than 10 days. Patients who received early (≤5 days from onset of symptoms) versus late (>5 days from onset of symptoms) remdesivir were compared. The primary outcome was a composite of high-flow nasal cannula, non-invasive or invasive mechanical ventilation, or death. A multivariate logistic regression analysis was performed to identify factors independently associated with the composite endpoint. FINDINGS: Among 312 consecutive patients with COVID-19 pneumonia who received remdesivir, 90 (28.8%) received early remdesivir, whereas 222 (71.2%) received late remdesivir. Twenty-nine patients (32.2%) in the early-remdesivir group versus 104 patients (46.8%) in the late-remdesivir group met the primary end point (P = 0.018). On multivariate analysis, a history of dyspnea at home (odds ratio = 2.53; 95% CI, 1.55–4.12; P < 0.001) was the strongest factor independently associated with the progression to severe COVID-19, whereas early-remdesivir use was a protective factor (odds ratio = 0.49; 95% CI, 0.27–0.87; P = 0.015). The delayed admission to the hospital was associated with a delayed administration of remdesivir. IMPLICATIONS: The early use of remdesivir (<5 days from symptoms onset) may reduce COVID-19 progression. The identification of patients who need early hospitalization and early remdesivir may provide clinical benefit in patients with COVID-19. Elsevier Inc. 2022-03 2022-01-17 /pmc/articles/PMC8761549/ /pubmed/35120742 http://dx.doi.org/10.1016/j.clinthera.2022.01.007 Text en © 2022 Elsevier Inc. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | COVID Original Research Falcone, Marco Suardi, Lorenzo Roberto Tiseo, Giusy Barbieri, Chiara Giusti, Lisa Galfo, Valentina Forniti, Arianna Caroselli, Claudio Della Sala, Leonardo Tempini, Sara Okoye, Chukwuma Monzani, Fabio Menichetti, Francesco Early Use of Remdesivir and Risk of Disease Progression in Hospitalized Patients With Mild to Moderate COVID-19 |
title | Early Use of Remdesivir and Risk of Disease Progression in Hospitalized Patients With Mild to Moderate COVID-19 |
title_full | Early Use of Remdesivir and Risk of Disease Progression in Hospitalized Patients With Mild to Moderate COVID-19 |
title_fullStr | Early Use of Remdesivir and Risk of Disease Progression in Hospitalized Patients With Mild to Moderate COVID-19 |
title_full_unstemmed | Early Use of Remdesivir and Risk of Disease Progression in Hospitalized Patients With Mild to Moderate COVID-19 |
title_short | Early Use of Remdesivir and Risk of Disease Progression in Hospitalized Patients With Mild to Moderate COVID-19 |
title_sort | early use of remdesivir and risk of disease progression in hospitalized patients with mild to moderate covid-19 |
topic | COVID Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8761549/ https://www.ncbi.nlm.nih.gov/pubmed/35120742 http://dx.doi.org/10.1016/j.clinthera.2022.01.007 |
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