含瑞德西韦治疗对住院COVID-19患者的疗效：一项前瞻性临床经验
Efficacy of Remdesivir-Containing Therapy in Hospitalized COVID-19 Patients: A Prospective Clinical Experience.
作者信息
Russo Alessandro, Binetti Erica, Borrazzo Cristian, Cacciola Elio Gentilini, Battistini Luigi, Ceccarelli Giancarlo, Mastroianni Claudio Maria, d'Ettorre Gabriella
机构信息
Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, 88100 Rome, Italy.
Policlinico "Umberto I", Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, 00185 Rome, Italy.
出版信息
J Clin Med. 2021 Aug 24;10(17):3784. doi: 10.3390/jcm10173784.
OBJECTIVES
Remdesivir is currently approved for the treatment of COVID-19. The recommendation for using remdesivir in patients with COVID-19 was based on the in vitro and in vivo activity of this drug against SARS-CoV-2.
METHODS
This was a prospective observational study conducted on a population of patients hospitalized for COVID-19. The primary endpoint of this study was the impact of remdesivir-containing therapy on 30-day mortality; the secondary endpoint was the impact of remdesivir-containing therapy on the need for high-flow oxygen therapy (HFNC), non-invasive ventilation (NIV), or mechanical ventilation. The data were analyzed after propensity score matching.
RESULTS
A total of 407 patients with SARS-CoV-2 pneumonia were consecutively enrolled. Out of these, 294 (72.2%) were treated with remdesivir and 113 (27.8%) were not. Overall, 61 patients (14.9%) were treated during hospitalization with HFNC, NIV, or mechanical ventilation, while 30-day mortality was observed in 21 patients (5.2%). Univariate analysis of patients treated with remdesivir or not showed no differences in 30-day mortality (4% vs. 6%, = 0.411) in the two study groups. Cox regression analysis, after propensity score matching, showed that therapies, including remdesivir-containing therapy, were not statistically associated with 30-day survival or mortality. The Kaplan-Meier curves of 30-day survival in patients treated with remdesivir or not before ( = 0.24) and after ( = 0.88) propensity score matching showed no differences between the two study groups. Finally, patients treated with remdesivir or not showed the same need for HFNC/NIV or mechanical ventilation.
CONCLUSIONS
This real-life experience of remdesivir use in hospitalized patients with COVID-19 was not associated with significant increases in rates of survival or reduced use of HFNC/NIV or mechanical ventilation compared with patients treated with other therapies not including remdesivir.
目的
瑞德西韦目前已被批准用于治疗新型冠状病毒肺炎（COVID-19）。针对COVID-19患者使用瑞德西韦的建议是基于该药物对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的体外和体内活性。
方法
这是一项针对因COVID-19住院患者群体开展的前瞻性观察性研究。本研究的主要终点是含瑞德西韦治疗对30天死亡率的影响；次要终点是含瑞德西韦治疗对高流量氧疗（HFNC）、无创通气（NIV）或机械通气需求的影响。在倾向得分匹配后对数据进行分析。
结果
共连续纳入407例SARS-CoV-2肺炎患者。其中，294例（72.2%）接受了瑞德西韦治疗，113例（27.8%）未接受治疗。总体而言，61例患者（14.9%）在住院期间接受了HFNC、NIV或机械通气治疗，21例患者（5.2%）观察到30天死亡率。对接受或未接受瑞德西韦治疗的患者进行单因素分析显示，两个研究组的30天死亡率无差异（4%对6%，P = 0.411）。倾向得分匹配后的Cox回归分析表明，包括含瑞德西韦治疗在内的各种治疗与30天生存率或死亡率无统计学关联。倾向得分匹配前（P = 0.24）和匹配后（P = 0.88）接受或未接受瑞德西韦治疗患者的30天生存Kaplan-Meier曲线显示，两个研究组之间无差异。最后结果显示，接受或未接受瑞德西韦治疗的患者对HFNC/NIV或机械通气的需求相同。
结论
与未使用瑞德西韦的其他治疗方法治疗的患者相比，在住院COVID-19患者中使用瑞德西韦的这一实际经验并未显著提高生存率，也未减少HFNC/NIV或机械通气的使用。
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