Remdesivir Use in Patients Requiring Mechanical Ventilation due to COVID-19

Giuseppe Lapadula; Davide Paolo Bernasconi; Giacomo Bellani; Alessandro Soria; Roberto Rona; Michela Bombino; Leonello Avalli; Egle Rondelli; Barbara Cortinovis; Enrico Colombo; Maria Grazia Valsecchi; Guglielmo Marco Migliorino; Paolo Bonfanti; Giuseppe Foti; Remdesivir-Ria Study Group

doi:10.1093/ofid/ofaa481

Remdesivir Use in Patients Requiring Mechanical Ventilation due to COVID-19

Open Forum Infect Dis. 2020 Oct 13;7(11):ofaa481. doi: 10.1093/ofid/ofaa481. eCollection 2020 Nov.

Authors

Giuseppe Lapadula¹, Davide Paolo Bernasconi², Giacomo Bellani^{3

4}, Alessandro Soria¹, Roberto Rona³, Michela Bombino³, Leonello Avalli³, Egle Rondelli³, Barbara Cortinovis³, Enrico Colombo³, Maria Grazia Valsecchi², Guglielmo Marco Migliorino¹, Paolo Bonfanti^{1

4}, Giuseppe Foti^{3

4}; Remdesivir-Ria Study Group

Collaborators

Affiliations

¹ Infectious Diseases Unit, San Gerardo Hospital, Monza, Italy.
² Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
³ Department of Emergency Medicine, San Gerardo Hospital, Monza, Italy.
⁴ Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.

Abstract

Background: Remdesivir has been associated with accelerated recovery of severe coronavirus disease 2019 (COVID-19). However, whether it is also beneficial in patients requiring mechanical ventilation is uncertain.

Methods: All consecutive intensive care unit (ICU) patients requiring mechanical ventilation due to COVID-19 were enrolled. Univariate and multivariable Cox models were used to explore the possible association between in-hospital death or hospital discharge, considered competing-risk events, and baseline or treatment-related factors, including the use of remdesivir. The rate of extubation and the number of ventilator-free days were also calculated and compared between treatment groups.

Results: One hundred thirteen patients requiring mechanical ventilation were observed for a median of 31 days of follow-up; 32% died, 69% were extubated, and 66% were discharged alive from the hospital. Among 33 treated with remdesivir (RDV), lower mortality (15.2% vs 38.8%) and higher rates of extubation (88% vs 60%), ventilator-free days (median [interquartile range], 11 [0-16] vs 5 [0-14.5]), and hospital discharge (85% vs 59%) were observed. Using multivariable analysis, RDV was significantly associated with hospital discharge (hazard ratio [HR], 2.25; 95% CI, 1.27-3.97; P = .005) and with a nonsignificantly lower mortality (HR, 0.73; 95% CI, 0.26-2.1; P = .560). RDV was also independently associated with extubation (HR, 2.10; 95% CI, 1.19-3.73; P = .011), which was considered a competing risk to death in the ICU in an additional survival model.

Conclusions: In our cohort of mechanically ventilated patients, RDV was not associated with a significant reduction of mortality, but it was consistently associated with shorter duration of mechanical ventilation and higher probability of hospital discharge, independent of other risk factors.

Keywords: COVID-19; SARS-CoV-2; antiviral treatment; coronavirus; critically ill patients; intensive care unit; remdesivir.