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Infectious Diseases

Association of Remdesivir Treatment With Survival and Length of Hospital Stay Among US Veterans Hospitalized With COVID-19

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Network Open

Published Online: July 15, 2021

Original Investigation

Article Information and Disclosures

Michael E. Ohl, MD, MSPH^1,2;

Donald R. Miller, ScD^3,4;

Brian C. Lund, PharmD¹;

Takaaki Kobayashi, MD^1,2;

Kelly Richardson Miell, PhD¹;

Brice F. Beck, MA¹;

Bruce Alexander, PharmD¹;

Kristina Crothers, MD^5,6;

Mary S. Vaughan Sarrazin, PhD^1,2

Author Affiliations

¹Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs (VA) Health Care System, Iowa City
²Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City
³Center for Healthcare Organization & Implementation Research, VA Bedford Health Care System, Bedford, Massachusetts
⁴Center for Population Health, Department of Biomedical & Nutritional Sciences, University of Massachusetts, Lowell
⁵VA Puget Sound Health Care System, Seattle, Washington
⁶Department of Internal Medicine, University of Washington, Seattle

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Key Points

Question Is remdesivir treatment associated with improved survival or shortened hospitalizations among people with COVID-19 in routine care settings?

Findings 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.

Meaning The findings suggest that routine use of remdesivir may be associated with increased use of hospital beds but not with improvements in survival.

Abstract

Importance 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.

Objective 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.

Exposures Remdesivir treatment.

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.

Results 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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Article Information

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 (michael-ohl@uiowa.edu).

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.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.