Remdesivir Decreases Mortality in COVID-19 Patients with Active Malignancy

SIMPLE SUMMARY: Patients with active malignancies have an increased risk for severe SARS-CoV-2 infection and high mortality from COVID-19. Additionally, due to the underlying immune deficiency, prolonged replication and a higher rate of escape mutations are seen. Thus, it is crucial to introduce direct antiviral agents, whereas there is only limited knowledge of their efficacy and optimal regimens mainly from small series in oncologic patients. In this real-world experience study, 252 patients with active malignancy were found among 4890 hospitalized patients for COVID-19. We have shown that patients with malignancy benefit from early remdesivir therapy, resulting in a decrease in 28-day in-hospital mortality by 80%. Factors independently associated with a worse prognosis include low glomerular filtration rate and low peripheral oxygen saturation at baseline. The results not only confirm the lifesaving effect of remdesivir in oncologic patients, but also underline the need to optimize therapy, including kidney protection and early oxygen therapy. ABSTRACT: Data on the use of remdesivir, the first antiviral agent against SARS-CoV-2, are limited in oncologic patients. We aimed to analyze contributing factors for mortality in patients with malignancies in the real-world CSOVID-19 study. In total, 222 patients with active oncological disorders were selected from a nationwide COVID-19 study of 4890 subjects. The main endpoint of the current study was the 28-day in-hospital mortality. Approximately half of the patients were male, and the majority had multimorbidity (69.8%), with a median age of 70 years. Baseline SpO(2) < 85% was observed in 25%. Overall, 59 (26.6%) patients died before day 28 of hospitalization: 29% due to hematological, and 20% due to other forms of cancers. The only factor increasing the odds of death in the multivariable model was eGFR < 60 mL/min/m(2) (4.621, p = 0.02), whereas SpO(2) decreased the odds of death at baseline (0.479 per 5%, p = 0.002) and the use of remdesivir (0.425, p = 0.03). This study shows that patients with COVID-19 and malignancy benefit from early remdesivir therapy, resulting in a decrease in early mortality by 80%. The prognosis was worsened by low glomerular filtration rate and low peripheral oxygen saturation at baseline underlying the role of kidney protection and early hospitalization.