Background and Aims

Remdesivir is FDA/EMA approved for the treatment of hospitalized COVID-19 patients and was shown to shorten time to recovery in RCTs. Real-world evidence for RDV utilization is sparse.

Methods

This retrospective study included adult COVID-19 US hospitalized patients (May-November-2020). Descriptive analyses of timing of RDV initiation, severity (oxygenation level) over time, in-hospital mortality by timing of RDV initiation, and overall mortality and ICU use are reported.

Results

Of the 190,529 patients hospitalized for COVID-19, 55,030 (29%) were treated with RDV. RDV patients had a mean age of 64 years, 69% were White, 15% Black, and 56% male.

From May to November, overall RDV utilization increased from 5% to 47%, while initiation of RDV on day 1 or 2 of the hospitalization increased from 40% to 85%. Similar trends were observed with steroid use.

In May, 68% of RDV patients were on low-flow or no oxygen at the time of RDV initiation, which increased to 86% in November.

Mortality was 12% for patients starting RDV on day 1/2 and 29% for patients starting after day 5 of hospitalization. Concurrently, ICU use decreased from 33% to 22% and overall mortality decreased from 14% to 9% over time.

Conclusions

Earlier use of RDV and in less severe patients was evident in the cohort over time, consistent with populations shown to have benefited in RCTs. While improvement in mortality and morbidity is clearly multifactorial, the changes in use of RDV towards patients more likely to derive benefits may have contributed to the overall trends.