Aksak-Wąs Bogusz Jan, Chober Daniel, Serwin Karol, Scheibe Kaja, Niścigorska-Olsen Jolanta, Niedźwiedź Anna, Dobrowolska Monika, Żybul Katarzyna, Kubacka Marta, Zimoń Agnieszka, Hołda Ewa, Mieżyńska-Kurtycz Joanna, Gryczman Marta, Jamro Grzegorz, Szakoła Paweł, Parczewski Miłosz
Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, Szczecin, Poland.
Department of Infectious, Tropical Diseases and Immune Deficiency, Provincial Hospital, Szczecin, Poland.
J Inflamm Res. 2022 Aug 25;15:4907-4920. doi: 10.2147/JIR.S378347. eCollection 2022.
Remdesivir is the first agent with proven clinical efficacy against coronavirus disease 2019 (COVID-19); however, its benefit is associated with early use, and its efficacy has been poorly studied in patients with hemato-oncological diseases, who have an increased risk of a severe course of infection. This study aimed to assess the effects of remdesivir on mortality, mechanical ventilation, and the duration of hospitalization in both the general population and in patients with hemato-oncological diseases.
Longitudinal data for 4287 patients with confirmed COVID-19 were analyzed, including a subset of 200 individuals with hemato-oncological diseases. In total, 1285 (30.0%) patients received remdesivir, while the remaining patients were treated with other methods. Survival statistics for the 14- and 30-day observation time points were calculated using non-parametric and multivariate Cox models.
Mortality for the 14- and 30-day observation time points was notably lower among patients receiving remdesivir (7.2% vs 11.6%, < 0.001 and 12.7% vs 16.0, = 0.005, respectively); however, in multivariate models adjusted for age, sex, lung involvement, and lactate dehydrogenase and interleukin-6 levels, the administration of remdesivir did not reduce patient mortality at either the 14-day or 30-day time points. Among patients with haemato-oncological disease, significant survival benefit was observed at 14 and 30 days for patients treated with remdesivir (11.3% vs.16.7% and 24.2% vs 26.1%, respectively; < 0.001). A favorable effect of remdesivir was also noted for the 14-day time point in multivariate survival analysis (HR:4.03 [95% confidence interval:1.37-11.88]; = 0.01).
Remdesivir significantly reduced the early mortality rate in COVID-19 patients with comorbid hemato-oncological disease, which emphasizes the need to administer this agent to immunosuppressed patients.
瑞德西韦是首个被证实对2019冠状病毒病（COVID-19）具有临床疗效的药物；然而，其疗效与早期使用相关，且在血液肿瘤疾病患者中其疗效研究较少，这类患者发生严重感染病程的风险增加。本研究旨在评估瑞德西韦对普通人群以及血液肿瘤疾病患者的死亡率、机械通气和住院时间的影响。
分析了4287例确诊COVID-19患者的纵向数据，其中包括200例血液肿瘤疾病患者的子集。共有1285例（30.0%）患者接受了瑞德西韦治疗，其余患者采用其他方法治疗。使用非参数和多变量Cox模型计算14天和30天观察时间点的生存统计数据。
接受瑞德西韦治疗的患者在14天和30天观察时间点的死亡率显著较低（分别为7.2%对11.6%，<0.001；12.7%对16.0%，=0.005）；然而，在根据年龄、性别、肺部受累情况以及乳酸脱氢酶和白细胞介素-6水平进行调整的多变量模型中，瑞德西韦的使用在14天或30天时间点均未降低患者死亡率。在血液肿瘤疾病患者中，接受瑞德西韦治疗的患者在14天和30天时观察到显著的生存获益（分别为11.3%对16.7%和24.2%对26.1%；<0.001）。在多变量生存分析中，瑞德西韦在14天时间点也显示出有利影响（HR：4.03[95%置信区间：1.37 - 11.88]；=0.01）。
瑞德西韦显著降低了合并血液肿瘤疾病的COVID-19患者的早期死亡率，这强调了对免疫抑制患者使用该药物的必要性。
