Remdesivir treatment and clinical outcome in non-severe hospitalized COVID-19 patients: a propensity score matching multicenter Italian hospital experience.

Autor: Attena E; Cardiology Unit, Monaldi Hospital - A.O.R.N. Dei Colli, Naples, Italy., Caturano A; Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy., Annunziata A; Sub-intensive Care Unit and Respiratory Pathophysiology Department, Cotugno Hospital - A.O.R.N. Dei Colli, Naples, Italy., Maraolo AE; First Division of Infectious Diseases, Cotugno Hospital - A.O.R.N. Dei Colli, Naples, Italy., De Rosa A; Respiratory Infectious Diseases Unit, Cotugno Hospital - A.O.R.N. Dei Colli, Naples, Italy., Fusco FM; Third Division of Infectious Diseases, Cotugno Hospital - A.O.R.N. Dei Colli, Naples, Italy., Halasz G; Cardiology Department, Guglielmo Da Saliceto Hospital, Piacenza, Italy., Dall'Ospedale V; Cardiology Department, University of Parma, Parma, Italy., Conte M; Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy., Parisi V; Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy., Galiero R; Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy., Sasso FC; Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy., Fiorentino G; Sub-intensive Care Unit and Respiratory Pathophysiology Department, Cotugno Hospital - A.O.R.N. Dei Colli, Naples, Italy., Russo V; Division of Cardiology, Department of Medical Translational Sciences, University of Campania Luigi Vanvitelli, Naples, Italy. v.p.russo@libero.it.
Jazyk: angličtina
Zdroj: European journal of clinical pharmacology [Eur J Clin Pharmacol] 2023 Jul; Vol. 79 (7), pp. 967-974. Date of Electronic Publication: 2023 May 22.
DOI: 10.1007/s00228-023-03499-z
Abstrakt: Introduction: Remdesivir exerts positive effects on clinical improvement, even though it seems not to affect mortality among COVID-19 patients; moreover, it was associated with the occurence of marked bradycardia.
Methods: We retrospectively evaluated 989 consecutive patients with non-severe COVID-19 (SpO 2  ≥ 94% on room air) admitted from October 2020 to July 2021 at five Italian hospitals. Propensity score matching allowed to obtain a comparable control group. Primary endpoints were bradycardia onset (heart rate < 50 bpm), acute respiratory distress syndrome (ARDS) in need of intubation and mortality.
Results: A total of 200 patients (20.2%) received remdesivir, while 789 standard of care (79.8%). In the matched cohorts, severe ARDS in need of intubation was experienced by 70 patients (17.5%), significantly higher in the control group (68% vs. 31%; p < 0.0001). Conversely, bradycardia, experienced by 53 patients (12%), was significantly higher in the remdesivir subgroup (20% vs. 1.1%; p < 0.0001). During follow-up, all-cause mortality was 15% (N = 62), significantly higher in the control group (76% vs. 24%; log-rank p < 0.0001), as shown at the Kaplan-Meier (KM) analysis. KM furthermore showed a significantly higher risk of severe ARDS in need of intubation among controls (log-rank p < 0.001), while an increased risk of bradycardia onset in the remdesivir group (log-rank p < 0.001). Multivariable logistic regression showed a protective role of remdesivir for both ARDS in need of intubation (OR 0.50, 95%CI 0.29-0.85; p = 0.01) and mortality (OR 0.18, 95%CI 0.09-0.39; p < 0.0001).
Conclusions: Remdesivir treatment emerged as associated with reduced risk of severe acute respiratory distress syndrome in need of intubation and mortality. Remdesivir-induced bradycardia was not associated with worse outcome.
(© 2023. The Author(s).)
Databáze: MEDLINE
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