Risk of death 54 percent lower with remdesivir added for hospitalized COVID-19 patients on O₂ support

The inclusion of remdesivir in the standard of care (SoC) is significantly associated with a 54-percent lower risk of death at day 28 among hospitalized adults with COVID-19 who require oxygen support, suggests a cross-study comparison that weight-balances patients from a clinical trial with those from a real-world study.

In a weighted comparison of patients requiring supplemental oxygen at baseline who were treated with remdesivir plus standard of care (SoC) from Study 5773 Part B and those who were treated with SoC alone from Study 5807, the adjusted mortality risk was more than halved with the addition of the antiviral agent (hazard ratio [HR], 0.46, 95 percent confidence interval [CI], 0.39–0.54; p<0.001).

The association with a mortality reduction remained significant across the three levels of oxygen support at baseline (low-flow [LF] oxygen, high-flow oxygen or noninvasive positive pressure ventilation [HF/NIPPV], and invasive mechanical ventilation or extracorporeal membrane oxygenation [IMV/ECMO]), with the greatest effect observed among patients receiving LF oxygen support (HR, 0.35, 95 percent CI, 0.26–0.46; p<0.001). [Clin Infect Dis 2024;79:1182-1189]

“Overall, a clearer picture begins to emerge: it seems that there are significant benefits associated with remdesivir, including reduced mortality and reduced time to recovery or hospital discharge,” wrote lead author Dr Dahlene Fusco, an infectious disease physician from the Department of Medicine, Tulane University School of Medicine in New Orleans, Louisiana, US. “These benefits consistently appear to be most pronounced if treatment with remdesivir is initiated before the patient progresses to requiring invasive ventilation.”