Remdesivir-associated survival outcomes among immunocompromised patients hospitalized for COVID-19: real-world evidence from the Omicron dominant era

Essy Mozaffari; Aastha Chandak; Robert L Gottlieb; Chidinma Chima-Melton; Mark Berry; Alpesh N Amin; Paul E Sax; Andre C Kalil

doi:10.1093/cid/ciae510

Remdesivir-associated survival outcomes among immunocompromised patients hospitalized for COVID-19: real-world evidence from the Omicron dominant era

Clin Infect Dis. 2024 Oct 15:ciae510. doi: 10.1093/cid/ciae510. Online ahead of print.

Authors

Essy Mozaffari¹, Aastha Chandak², Robert L Gottlieb^{3

4

5

6}, Chidinma Chima-Melton^{7

8}, Mark Berry¹, Alpesh N Amin⁹, Paul E Sax¹⁰, Andre C Kalil¹¹

Affiliations

¹ Gilead Sciences, Foster City, California, USA.
² Certara, New York, New York, USA.
³ Baylor University Medical Center, Dallas, Texas, USA.
⁴ Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas, USA.
⁵ Baylor Scott & White The Heart Hospital, Plano, Texas, USA.
⁶ Baylor Scott & White Research Institute, Dallas, Texas, USA.
⁷ Tele-ICU Inc, Los Angeles, California, USA.
⁸ Pipeline Health System, Los Angeles, California, USA.
⁹ University of California, Irvine, California, USA.
¹⁰ Brigham and Women's Hospital, Boston, Massachusetts, USA.
¹¹ University of Nebraska Medical Center, Omaha, Nebraska, USA.

PMID: 39405443
DOI: 10.1093/cid/ciae510

Abstract

Background: Patients with immunocompromising conditions are at an increased risk for coronavirus disease 2019 (COVID-19)-related hospitalizations and mortality. Randomized clinical trials provide limited enrollment, if any, to inform outcomes of such patients treated with remdesivir.

Methods: Using the US PINC AI Healthcare Database, we identified adult patients with immunocompromising conditions, hospitalized for COVID-19 between December 2021 and February 2024. Primary outcome was all-cause inpatient mortality examined in propensity score (PS) matched patients in remdesivir versus non-remdesivir groups. Subgroup analyses were performed for patients with cancer, hematologic malignancies, and solid organ/hematopoietic stem cell transplant recipients.

Results: Of 28,966 patients included in the study, 16,730 (58%) received remdesivir during first two days of hospitalization. After PS matching, 8,822 patients in remdesivir and 8,822 patients in non-remdesivir group were analyzed. Remdesivir was associated with a significantly lower mortality among patients with no supplemental oxygen (aHR [95% CI]: 14-day, 0.73 [0.62-0.86]; 28-day, 0.79 [0.68-0.91]) and among those with supplemental oxygen (14-day, 0.75 [0.67-0.85]; 28-day, 0.78 [0.70-0.86]). Remdesivir was also associated with lower mortality in subgroups of patients with cancer, hematological malignancies (including leukemia, lymphoma, and multiple myeloma), and solid organ/hematopoietic stem cell transplantation.

Conclusions: In this large cohort of patients with immunocompromising conditions hospitalized for COVID-19, remdesivir was associated with significant improvement in survival, including patients with varied underlying immunocompromising conditions. The integration of current real-world evidence into clinical guideline recommendations can inform clinical communities to optimize treatment decisions in the evolving COVID-19 era, extending beyond the conclusion of the public health emergency declaration.

Keywords: COVID-19; cancer; data science; hematological malignancy; immunocompromised; leukemia; lymphoma; multiple myeloma; propensity score; real-world data; remdesivir; transplantation.