Remdesivir Did Not Improve Mortality at Hospitals, Prolonged Stays

Remdesivir was not associated with improved survival in a large study of U.S. veterans, but length of hospitalization was longer.

The study, published in JAMA Network Open, included 2344 U.S. veterans hospitalized with COVID-19 at 123 hospitals from May 1 to October 8, 2020. Associations between remdesivir treatment, survival, and length of hospital stay were examined.

“The takeaway message was that remdesivir treatment was not associated with greater survival, but was associated with a longer length of hospital stay,” Michael Ohl, MD, MSPH, associate professor of internal medicine-infectious disease at the University of Iowa Carver College of Medicine told Contagion. “The median length of stay was 3 days longer for people who received remdesivir compared to those who did not.”

The study included 1172 patients who received remdesivir and 11 matched controls. The groups were similar in age, with an average of about 67 years old, 93.9% were men, 47.7% received dexamethasone and about one-fifth were admitted to intensive care units.

All-cause mortality within 30 days was 12.2% among the remdesivir group compared with 10.6% among the control group. Results were similar regardless of use of the corticosteroid dexamethasone. Median time to hospital discharge was 6 days among the remdesivir group compared with 3 days for the control group.

“We were surprised to find the longer length of stay for people who received remdesivir,” Ohl said. “The Adaptive COVID-19 Treatment Trial 1, a randomized clinical trial comparing remdesivir to placebo, had previously found that remdesivir treatment shorted time to clinical recovery. We therefore expected that people would be able to go home from the hospital sooner after receiving remdesivir. In our study of remdesivir use in ‘real world care settings,' examination of the timing of remdesivir treatment and hospital discharge suggested that clinicians were keeping some patients in the hospital simply to complete 5 or 10-day remdesivir courses, even though the patients may otherwise have been ready to leave the hospital sooner. This likely contributed to longer hospital stays. The implication is that routine use of remdesivir may have led to an unintended consequence of increased use of hospital beds during the COVID-19 pandemic, without improving outcomes.”

The study authors noted that mixed results of studies of remdesivir for COVID-19 have complicated recommendations for use of the intravenous antiviral treatment, which was originally developed to treat Ebola.

“It is reasonable to follow the NIH and Infectious Disease Society of America guidelines for remdesivir use, but clinicians should avoid admitting people or keeping people in hospital solely to receive remdesivir if they do not meet other criteria for hospitalization,” Ohl said.

Limitations of the study included the possibility of residual differences in illness severity, the study included only 49.5% of patients receiving remdesivir who were able to be matched with controls, and limited data prevented the identification of specific subgroups who may have seen more benefit from remdesivir treatment.

Remdesivir was the first drug to receive full FDA approval for the treatment of COVID-19 in the United States, when the FDA authorized its use in October after granting Emergency Use Authorization in May. It was among the daily treatment regimen former President Donald Trump received for COVID-19.

“Treatments for COVID-19 are evolving rapidly,” Ohl said. “We are examining more recent data to determine if remdesivir treatment is still associated with longer length of stay, or if clinicians have modified behavior to send people home earlier when appropriate. We are also working to get the message out to clinicians that they should not keep people in hospital simply to give remdeisvir.”