Reduced risk of death in people with SARS-CoV-2 infection treated with remdesivir: a nested case–control study

Abstract

Introduction

Since the start of the SARS-CoV-2 pandemic, several treatment options have been proposed (e.g. steroids, heparin, antivirals and monoclonal antibodies). Remdesivir was the first antiviral approved for the treatment of COVID-19, even though controversial evidence exists concerning the efficacy. Therefore, we aimed to conduct a study to evaluate whether the use of remdesivir was associated with lower mortality in patients with COVID-19.

Methods

We conducted a nested case–control study of a retrospective cohort collecting medical records of people with SARS-CoV-2 infection admitted in the infectious Disease Unit of Sassari University Hospital (S.C. Clinica di Malattie Infettive, AOU di Sassari, Italy), or in the Infectious Disease Unit of Foggia (AOU “Ospedali Riuniti” Foggia), between 1 July 2020 and 10 November 2021. The outcome considered was death; thus, we matched death (cases) to survivors (controls) by sex and age (1:1).

Results

We included in the study 342 patients, with 171 deaths (cases) and 171 survivors (controls). Remdesivir was administered to 60 people in the control group and to 18 people in the case group (35.1% vs. 10.5%, p < .0001). In the multivariate analysis, treatment with remdesivir and heparin was associated with lower mortality (OR: 0.19 [95% CI :0.10–0.38], p <.0001; OR: 0.39 [95% CI: 0.21–0.74] p = .004, respectively). On the contrary, diabetes, oxygen therapy and CPAP/NIV were associated with higher mortality.

Conclusion

Our study showed lower mortality in people with SARS-CoV-2 infection treated with remdesivir.

Keywords:

• COVID-19
• remdesivir
• SARS-CoV-2
• COVID-19 treatment
• antiviral
• case–control study
• mortality
• Italy

Transparency

Declaration of funding

This research has not received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Declaration of financial/other relationships

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.

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

Table 1. Characteristics of 342 patients affected by SARS-CoV-2 infection enrolled in a nested case–control study in Sassari and Foggia, Italy.

Table 2. Logistic regression analysis to assess the relationship between sociodemographic and clinical variables, and 28 day mortality in 342 patients affected by SARS-CoV-2 infection enrolled in a nested case–control study in Sassari and Foggia, Italy.

Author contributions

Conceptualization: A.D.V., M.P., S.L.C. and G.M. Investigation: A.C., B.Z., T.S., M.C.M., M.F., C.F., A.F. and V.F. Formal analysis: G.S., M.V.P. and L.S. Methodology: A.D,V., M.P., G.S., S.B. and G.M. Validation: A.F. and S.L.C. Visualization: A.C., B.Z., M.F., T.S., M.V.P. and L.S. Resources: C.F. and V.F. Writing – original draft: A.D.V., M.P., A.C., G.S. and G.M. Writing – review and editing: B.Z., M.V.P., T.S., M.C.M., M.F., C.F., L.S., A.F., V.F., S.B. and S.L.C.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.