Patterns of corticosteroid use among remdesivir and matched patients and associated clinical outcomes in hospitalized COVID-19 patients

ABSTRACT

Introduction

We aimed to investigate patterns of corticosteroid use and their relationship with remdesivir use and clinical outcomes in a large real-life cohort of COVID-19 patients treated in a tertiary-level institution.

Methods

We retrospectively analyzed a total of 1558 severe and critical COVID-19 patients, including 779 patients treated with remdesivir and 779 matched control patients.

Results

A total of 167 (10.7%) patients received none, 710 (45.6%) low, 539 (34.6%) high, and 142 (9.1%) very high corticosteroid doses. Patients treated with remdesivir had significantly longer exposure to corticosteroids, received higher average and maximal daily doses, and cumulative corticosteroid doses. In the multivariate analysis remdesivir use, lower cumulative comorbidity burden, higher severity of COVID-19 symptoms, and mechanical ventilation were recognized as mutually independent predictors of the use of higher corticosteroid doses. Higher corticosteroid doses were associated with significantly increased mortality.

Among non-remdesivir treated patients, there was a U-shaped relationship between maximal daily corticosteroid dose and mortality. Among remdesivir treated patients gradual increase in mortality with increasing corticosteroid doses was observed.

Conclusion

Patterns of corticosteroid use differ regarding the use of remdesivir and may moderate its association with survival among severe and critical COVID-19 patients.

KEYWORDS:

• Remdesivir
• corticosteroids
• prognosis
• dexamethasone, methylprednisolone
• prednisone

Article highlights

• Patterns of corticosteroid use for COVID-19 substantially differ regarding the use of remdesivir

• Higher corticosteroid doses were associated with significantly increased mortality

• Corticosteroids might moderate association of remdesivir with survival

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Author contributions

I Papic and M Lucijanic designed the study. I Papic, P Bistrovic, T Keres and M Lucijanic collected data. M Lucijanic performed statistical analyses. I Papic and M Lucijanic drafted and critically revised the manuscript. I Papic, P Bistrovic, T Keres, M Ortner Hadziabdic and M Lucijanic interpreted data, critically revised the manuscript for important intellectual content, approved the final version of the manuscript and agreed to be accountable for all aspects of the work.

Institutional review board statement

The study was approved by the University Hospital Dubrava Review Board (nm. 2021/2503–04). The study was conducted in accordance with the Declaration of Helsinki.

Informed consent statement

Informed consent from participants was waived due to retrospective study design and anonymization of patients using identification numbers.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.