Mozaffari Essy, Chandak Aastha, Gottlieb Robert L, Chima-Melton Chidinma, Berry Mark, Oppelt Thomas, Okulicz Jason F, Amin Alpesh N, Welte Tobias, Sax Paul E, Kalil Andre C
Global Medical Affairs, Gilead Sciences, Foster City, California, USA.
Evidence & Access, Certara, New York, New York, USA.
Clin Infect Dis. 2025 Feb 5;80(1):63-71. doi: 10.1093/cid/ciae477.
Treatment guidelines were developed early in the pandemic when much about coronavirus disease 2019 (COVID-19) was unknown. Given the evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), real-world data can provide clinicians with updated information. The objective of this analysis was to assess mortality risk in patients hospitalized for COVID-19 during the Omicron period receiving remdesivir + dexamethasone versus dexamethasone alone.
A large, multicenter US hospital database was used to identify adult patients hospitalized with a primary discharge diagnosis of COVID-19 flagged as "present-on-admission" and treated with remdesivir + dexamethasone or dexamethasone alone between December 2021 and April 2023. Patients were matched using 1:1 propensity score matching and stratified by baseline oxygen requirements. Cox proportional hazards model was used to assess time to 14- and 28-day in-hospital all-cause mortality.
A total of 33 037 patients were matched, with most patients ≥65 years old (72%), White (78%), and non-Hispanic (84%). Remdesivir + dexamethasone was associated with lower mortality risk versus dexamethasone alone across all baseline oxygen requirements at 14-days (no supplemental oxygen charges: adjusted hazard ratio [95% confidence interval {CI}]: 0.79 [.72-.87], low flow oxygen: 0.70 [.64-.77], high flow oxygen/non-invasive ventilation: 0.69 [.62-.76], invasive mechanical ventilation/extracorporeal membrane oxygen (IMV/ECMO): 0.78 [.64-.94]), with similar results at 28-days.
Remdesivir + dexamethasone was associated with a significant reduction in 14- and 28-day mortality compared to dexamethasone alone in patients hospitalized for COVID-19 across all levels of baseline respiratory support, including IMV/ECMO. However, the use of remdesivir + dexamethasone still has low clinical practice uptake. In addition, these data suggest a need to update the existing guidelines.
在新冠疫情早期，当2019冠状病毒病（COVID-19）的许多情况尚不明时，治疗指南就已制定。鉴于严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的演变，真实世界的数据可为临床医生提供最新信息。本分析的目的是评估在奥密克戎时期因COVID-19住院的患者接受瑞德西韦+地塞米松与单独使用地塞米松相比的死亡风险。
使用一个大型的美国多中心医院数据库，以识别2021年12月至2023年4月期间因COVID-19住院且主要出院诊断标记为“入院时存在”，并接受瑞德西韦+地塞米松或单独使用地塞米松治疗的成年患者。使用1:1倾向评分匹配对患者进行匹配，并根据基线氧需求进行分层。使用Cox比例风险模型评估14天和28天院内全因死亡率的时间。
共匹配了33037名患者，大多数患者年龄≥65岁（72%），为白人（78%），非西班牙裔（84%）。在所有基线氧需求水平下，14天时瑞德西韦+地塞米松与单独使用地塞米松相比，死亡风险较低（无需补充氧气：调整后风险比[95%置信区间{CI}]：0.79[0.72-0.87]，低流量吸氧：0.70[0.64-0.77]，高流量吸氧/无创通气：0.69[0.62-0.76]，有创机械通气/体外膜肺氧合（IMV/ECMO）：0.78[0.64-0.94]），28天时结果相似。
在因COVID-19住院的患者中，无论基线呼吸支持水平如何，包括IMV/ECMO，与单独使用地塞米松相比，瑞德西韦+地塞米松可显著降低14天和28天的死亡率。然而，瑞德西韦+地塞米松在临床实践中的应用率仍然较低。此外，这些数据表明需要更新现有指南。
