A brand new examine of outcomes amongst greater than 33,000 hospitalized COVID-19 sufferers reveals that remdesivir plus dexamethasone administration is related to decrease mortality charges at 14 and 28 days in contrast with dexamethasone alone, based on findings in Scientific Infectious Illnesses.
The retrospective, comparative effectiveness examine used knowledge on 33,037 US sufferers to match outcomes of the anti-inflammatory drug dexamethasone alone or co-administered with the antiviral remedy remdesivir.
All sufferers have been hospitalized when the Omicron variant was probably the most dominant pressure in the US: December 2021 to April 2023. The principle final result was all-cause inpatient mortality at 14 and 28 days after the baseline interval.
The examine started with 61,236 sufferers who got remdesivir and dexamethasone inside 2 days of hospitalization and 36,489 who initiated dexamethasone monotherapy within the first 2 days of hospitalization. For the ultimate evaluation, 33,037 remdesivir and dexamethasone sufferers have been matched to 33,037 dexamethasone monotherapy sufferers.
Most sufferers acquired supplemental oxygen
For each remedy teams, most sufferers have been over 65 (67% to 70%), White (77% to 78%), and 45% didn’t obtain supplemental oxygen. Amongst those that did obtain oxygen, 37% acquired low-flow, 17% high-flow, and three% both invasive mechanical air flow or extracorporeal membrane oxygenation.
For individuals who didn’t use supplemental oxygen, 5.6% and seven.2% of remdesivir and dexamethasone sufferers died inside 14 and 28 days, respectively, in contrast with 6.1% and seven.7% of dexamethasone monotherapy sufferers.
For sufferers receiving low-flow oxygen, 6.1% and eight.1% of mixture sufferers died inside 14 and 28 days, respectively, in contrast with 7.7% and 9.7% of dexamethasone monotherapy sufferers. For sufferers receiving high-flow oxygen, 12.7% and 17.6% of remdesivir and dexamethasone sufferers died inside 14 and 28 days, respectively, in contrast with 15.7% and 20.7% of dexamethasone monotherapy sufferers, the authors stated.
Findings replace outdated RCTs
For sufferers ventilated or on extracorporeal membrane oxygenation, 23.5% and 32.7% of remdesivir and dexamethasone sufferers died inside 14 and 28 days, respectively, in contrast with 27.1% and 35.4% of dexamethasone monotherapy sufferers.
“Our examine highlights that the addition of remdesivir to dexamethasone is related to a big survival profit in comparison with dexamethasone with out remdesivir use,” the authors concluded. “This discovering is seen in sufferers with out supplemental oxygen requirement (a gaggle for whom dexamethasone utilization is contraindicated until for a pre-existing or for remedy of a non-COVID-19 situation) in addition to in sufferers with hypoxemia throughout the spectrum of oxygen help necessities, for whom the addition of remdesivir improves outcomes additional.”
In a commentary on the examine from Todd C. Lee, MD, MPH, of McGill College, Lee stated the examine up to date the understanding and medical use of the medicine in a post-vaccine period. Most knowledge on the efficacy of remdesivir and dexamethasone got here from randomized management trails (RCTs) early within the pandemic, earlier than vaccination, boosters, and widespread pure immunity. To evaluate these medicine within the post-COVID-emergency period, observational research have to be used.
“Each the observational and RCT stage proof reveals that when you have COVID pneumonia with an actual requirement for oxygen, you need to obtain dexamethasone, remdesivir, and doubtlessly an IL-6or JAK inhibitor,” Lee stated.
When you’ve got COVID pneumonia with an actual requirement for oxygen, you need to obtain dexamethasone, remdesivir, and doubtlessly an IL-6or JAK inhibitor.
For sufferers who’re hospitalized however don’t require supplemental oxygen remedy, “It’s possible that remdesivir nonetheless shortens the period of sickness, and it could scale back mortality, however the profit is sort of actually much less placing than within the preliminary non-immune inhabitants within the RCTs.”
