Evaluation of Remdesivir to the outcomes of hospitalized patients with COVID-19 infection in a tertiary-care hospital in southern India

Authors

  • Hanna Alexander Department of Infectious Diseases, Christian Medical College, Vellore, Tamilnadu, India https://orcid.org/0000-0002-5943-1695
  • Karthik Gunasekaran Department of Medicine, Christian Medical College, Vellore, Tamilnadu, India
  • Jisha Sara John Department of Infectious Diseases, Christian Medical College, Vellore, Tamilnadu, India https://orcid.org/0000-0002-9025-9678
  • Naveena Gracelin Princy Zacchaeus Department of Infectious Diseases, Christian Medical College, Vellore, Tamilnadu, India https://orcid.org/0000-0002-0220-2496
  • Prasanna Samuel Department of Biostatistics, Christian Medical College, Vellore,Tamilnadu, India
  • Sudha Jasmine Department of Medicine, Christian Medical College, Vellore, Tamilnadu, India
  • Devasahayam Jesudas Christopher Department of Pulmonary Medicine, Christian Medical College,Vellore, Tamilnadu, India
  • Kishore Pichamuthu Department of Critical care Medicine, Christian Medical College, Vellore, Tamilnadu, India
  • Priscilla Rupali Department of Infectious Diseases, Christian Medical College, Vellore, Tamilnadu, India https://orcid.org/0000-0002-5115-067X

DOI:

https://doi.org/10.3855/jidc.16642

Keywords:

Nested case‐control study, Remdesivir, COVID-19

Abstract

Introduction: Remdesivir was the only antiviral used in the treatment of COVID-19 in the first wave of the COVID-19 pandemic, following the adaptive COVID-19 treatment trial-1 interim analysis report. However, its use in moderate to critical hospitalized COVID-19 patients continues to be controversial.

Methodology: In a cohort of 1,531 moderate to critical COVID-19 patients, we retrospectively performed a nested case-control study where 515 patients on Remdesivir were compared to 411 patients with no Remdesivir. Cases and controls were matched for age, sex and severity. The primary outcome was in-hospital mortality and secondary outcomes were duration of hospital stay, need for intensive care unit (ICU), progression to oxygen therapy, progression to non-invasive ventilation, progression to mechanical ventilation, and duration of ventilation.

Results: Mean age of the cohort was 57.05 + 13.5 years. 75.92% were males. Overall, in-hospital mortality was 22.46% (n = 208). There was no statistically significant difference in all-cause mortality among cases and controls (20.78% vs. 24.57%, p = 0.17). Progression to non-invasive ventilation was lower in the Remdesivir group (13.6% vs 23.7%, p < 0.001), however progression to mechanical ventilation was higher in the Remdesivir group (11.3% vs 2.7%, p value < 0.001*). In a subgroup analysis of critically ill patients, the use of Remdesivir lowered mortality (OR 0.32 95% CI: 0.13 - 0.75).

Conclusions: Remdesivir did not decrease the in-hospital mortality in moderate to severe COVID-19 but decreased progression to non-invasive ventilation. Its mortality benefit in critically ill patients needs further evaluation. Remdesivir may be useful if given early in the treatment of patients with moderate COVID-19.

Author Biographies

Hanna Alexander, Department of Infectious Diseases, Christian Medical College, Vellore, Tamilnadu, India

Clinical Pharmacist,Department of Infectious diseases

Karthik Gunasekaran, Department of Medicine, Christian Medical College, Vellore, Tamilnadu, India

Associate Professor,Department of Medicine

Jisha Sara John, Department of Infectious Diseases, Christian Medical College, Vellore, Tamilnadu, India

Clinical pharmacist, Department of Infectious diseases

Naveena Gracelin Princy Zacchaeus, Department of Infectious Diseases, Christian Medical College, Vellore, Tamilnadu, India

Project coordinator, Department of Infectious Diseases

Prasanna Samuel, Department of Biostatistics, Christian Medical College, Vellore,Tamilnadu, India

Professor, Department of Biostatistics

Sudha Jasmine, Department of Medicine, Christian Medical College, Vellore, Tamilnadu, India

Professor, Department of medicine

Devasahayam Jesudas Christopher, Department of Pulmonary Medicine, Christian Medical College,Vellore, Tamilnadu, India

Professor, Department of Pulmonary Medicine

Kishore Pichamuthu, Department of Critical care Medicine, Christian Medical College, Vellore, Tamilnadu, India

Professor, Department of Critical Care Medicine

Downloads

Published

2023-03-31

How to Cite

1.
Alexander H, Gunasekaran K, Sara John J, Gracelin Princy Zacchaeus N, Samuel P, Jasmine S, Devasahayam Jesudas Christopher, Pichamuthu K, Rupali P (2023) Evaluation of Remdesivir to the outcomes of hospitalized patients with COVID-19 infection in a tertiary-care hospital in southern India. J Infect Dev Ctries 17:304–310. doi: 10.3855/jidc.16642

Issue

Section

Coronavirus Pandemic