Is remdesivir treatment associated with improved survival or shortened hospitalizations among people with COVID-19 in routine care settings?
In this cohort study of 2344 US veterans hospitalized with COVID-19, remdesivir therapy was not associated with improved 30-day survival but was associated with a significant increase in median time to hospital discharge.
The findings suggest that routine use of remdesivir may be associated with increased use of hospital beds but not with improvements in survival.
Randomized clinical trials have yielded conflicting results about the effects of remdesivir therapy on survival and length of hospital stay among people with COVID-19.
To examine associations between remdesivir treatment and survival and length of hospital stay among people hospitalized with COVID-19 in routine care settings.
Design, Setting, and Participants
This retrospective cohort study used data from the Veterans Health Administration (VHA) to identify adult patients in 123 VHA hospitals who had a first hospitalization with laboratory-confirmed COVID-19 from May 1 to October 8, 2020. Propensity score matching of patients initiating remdesivir treatment to control patients who had not initiated remdesivir treatment by the same hospital day was used to create the analytic cohort.
Main Outcomes and Measures
Time to death within 30 days of remdesivir treatment initiation (or corresponding hospital day for matched control individuals) and time to hospital discharge with time to death as a competing event. Associations between remdesivir treatment and these outcomes were assessed using Cox proportional hazards regression in the matched cohort.
The initial cohort included 5898 patients admitted to 123 hospitals, 2374 (40.3%) of whom received remdesivir treatment (2238 men [94.3%]; mean [SD] age, 67.8 [12.8] years) and 3524 (59.7%) of whom never received remdesivir treatment (3302 men [93.7%]; mean [SD] age, 67.0 [14.4] years). After propensity score matching, the analysis included 1172 remdesivir recipients and 1172 controls, for a final matched cohort of 2344 individuals. Remdesivir recipients and matched controls were similar with regard to age (mean [SD], 66.6 [14.2] years vs 67.5 [14.1] years), sex (1101 men [93.9%] vs 1101 men [93.9%]), dexamethasone use (559 [47.7%] vs 559 [47.7%]), admission to the intensive care unit (242 [20.7%] vs 234 [19.1%]), and mechanical ventilation use (69 [5.9%] vs 45 [3.8%]). Standardized differences were less than 10% for all measures. Remdesivir treatment was not associated with 30-day mortality (143 remdesivir recipients [12.2%] vs 124 controls [10.6%]; log rank P = .26; adjusted hazard ratio [HR], 1.06; 95% CI, 0.83-1.36). Results were similar for people receiving vs not receiving dexamethasone at remdesivir initiation (dexamethasone recipients: adjusted HR, 0.93; 95% CI, 0.64-1.35; nonrecipients: adjusted HR, 1.19; 95% CI, 0.84-1.69). Remdesivir recipients had a longer median time to hospital discharge compared with matched controls (6 days [interquartile range, 4-12 days] vs 3 days [interquartile range, 1-7 days]; P < .001).
Conclusions and Relevance
In this cohort study of US veterans hospitalized with COVID-19, remdesivir treatment was not associated with improved survival but was associated with longer hospital stays. Routine use of remdesivir may be associated with increased use of hospital beds while not being associated with improvements in survival.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: April 22, 2021.
Published: July 15, 2021. doi:10.1001/jamanetworkopen.2021.14741
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Ohl ME et al. JAMA Network Open.
Corresponding Author: Michael E. Ohl, MD, MSPH, Department of Internal Medicine, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, SW34 GH, Iowa City, IA 52242 (email@example.com).
Author Contributions: Drs Ohl and Vaughan Sarrazin had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Ohl, Miller, Lund, Kobayashi, Crothers.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Ohl, Kobayashi, Richardson Miell, Alexander, Vaughan Sarrazin.
Critical revision of the manuscript for important intellectual content: Ohl, Miller, Lund, Kobayashi, Richardson Miell, Beck, Crothers, Vaughan Sarrazin.
Statistical analysis: Miller, Kobayashi, Vaughan Sarrazin.
Obtained funding: Ohl, Miller.
Administrative, technical, or material support: Miller, Lund, Richardson Miell.
Supervision: Lund, Richardson Miell, Vaughan Sarrazin.
Conflict of Interest Disclosures: Dr Ohl reported receiving grants from Veterans Affairs Health Services Research and Development during the conduct of the study and consulting for Gilead Pharmaceuticals outside the submitted work. Dr Lund reported receiving grants from the US Department of Veterans Affairs during the conduct of the study. Mr Beck reported receiving grants from the Veterans Health Administration during the conduct of the study. Dr Alexander reported receiving grants from the US Department of Veterans Affairs during the conduct of the study and serving as a contract data manager for the Iowa City Veterans Affairs Medical Center Research Department outside the submitted work. No other disclosures were reported.
Funding/Support: This study was supported by award C19-20-404 from the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (Dr Ohl).
Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Disclaimer: The views expressed herein are those of the authors and do not necessarily reflect the views of the US Department of Veterans Affairs.
Additional Contributions: Michihiko Goto, MD, MS, and Cassie Goedken, MPH, Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs, provided assistance with the production of tables and figures and did not receive compensation.
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