Publication date: Jul 14, 2023

Clinical trials show different effects of remdesivir on clinical outcomes relative to COVID-19 severity at hospital admission; in Europe, there are few real-world data. A multicentre, multinational retrospective cohort study in adult patients hospitalised with PCR-confirmed COVID-19 was conducted to understand remdesivir clinical use in different countries and to describe outcomes for patients receiving remdesivir stratified by oxygen use. Primary endpoints were all-cause mortality at day 28 and hospitalisation duration. Patients were categorised by baseline disease severity: no supplemental oxygen (NSO); low flow oxygen ≤ 6 litres (l)/minute (LFO); high flow oxygen > 6 l/minute (HFO). Four hundred and forty-eight (448) patients (72 [16. 1%] HFO; 295 [65. 8%] LFO; 81 (18. 1%] NSO) were included; median age was 65 years and 64% were male. Mortality was higher in patients on HFO (rate 23. 6%) compared to LFO (10. 2%; p=0. 001) or NSO (6. 2%; p=0. 002). Duration of hospitalisation was longer in patients on HFO (13 days) compared to LFO (9 days; p=0. 003) and NSO (9 days; p=0. 021). Patients who initiated remdesivir ≥2 days compared to within a day of hospitalisation had a 4. 2 times higher risk of death, irrespective of age, sex, comorbidities, and oxygen support at baseline. Requirement for mechanical ventilation/ECMO and readmission within 28 days of discharge was similar across groups. Remdesivir use and outcomes differed by country. A higher mortality rate and duration of hospitalisation was seen in remdesivir-treated COVID-19 patients on HFO compared to LFO and NSO. Initiation of remdesivir upon admission as opposed to delayed initiation has a mortality benefit.

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