Remdesivir, steroids tied to better COVID hospital outcomes

The antiviral drug remdesivir and corticosteroids were linked to better outcomes in COVID-19 patients admitted directly to a hospital ward in the Netherlands, suggests a real-world study published today in Open Forum Infectious Diseases.

The nationwide study, led by University of Amsterdam researchers, involved 5,643 COVID-19 patients admitted to 11 hospitals during four pandemic waves, from Feb 27, 2020, to Dec 31, 2021. Patients received remdesivir, corticosteroids, the antimalarial drug hydroxychloroquine, immune-suppressing interleukin-6 (IL-6) antagonists, or combinations thereof; intensive care unit (ICU) patients didn't receive remdesivir.

Over the four waves, overall median age fell from 67 to 64 years, and in-hospital death rates dropped from 21% to 15%. Of the 5,187 patients admitted directly to a ward, median age was 66 years, 59% were men, 13% were later admitted to an ICU, and 17% died in the hospital. Median age in the 456 patients admitted directly to an ICU was 65 years, 75% were men, 26% died in the ICU, and 33% died during admission.

Among patients admitted directly to a ward, remdesivir was linked to a higher rate of hospital release within 29 days (hazard ratio [HR], 1.16), and corticosteroids were tied to a lower likelihood of in-hospital death (HR, 0.81) and death by 12 weeks (HR, 0.84). Hydroxychloroquine was associated with an increased risk of death (HR, 1.54), and the results of IL-6 antagonists were inconclusive.

In patients admitted directly to an ICU, hydroxychloroquine, corticosteroids, and IL-6 antagonists weren't tied to a lower risk of death or hospital release alive.

The authors cautioned that changes in the predominant circulating SARS-CoV-2 variants, patient COVID-19 vaccination status, and use of noninvasive ventilation and high-flow nasal oxygen therapy during the study likely influenced the study outcomes and treatment effects.

"Given the ongoing evolution of the SARS-CoV-2 virus with novel clinically significant mutants appearing at a steady state during changing patient's characteristics over time, it is essential to continuously re-evaluate the real-world effectiveness of newly introduced drugs to treat COVID19," they wrote.

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