Impact of remdesivir according to the pre-admission symptom duration in patients with COVID-19
Authors: Garcia-Vidal Carolina , Alonso Rodrigo , Camon Ana M , Cardozo Celia , Albiach Laia , Agüero Daiana , Marcos M Angeles , Ambrosioni Juan , Bodro Marta , Chumbita Mariana , de la Mora Lorena , Garcia-Pouton Nicole , Dueñas Gerard , Hernandez-Meneses Marta , Inciarte Alexy , Cuesta Genoveva , Meira Fernanda , Morata Laura , Puerta-Alcalde Pedro , Herrera Sabina , Tuset Montse , Castro Pedro , Prieto-Gonzalez Sergio , Almuedo-Riera Alex , Mensa Josep , Martínez José Antonio , Sanjuan Gemma , Nicolas J M , del Rio A , Muñoz José , Vila Jordi , Garcia Felipe , Soriano Alex ,   the Hospital Clinic of Barcelona COVID-19 Research Group, Blanco J L , Mallolas J , Martínez E , Martínez M , Miró J M , Moreno A , Solá M , Ugarte A , Gonzalez-Cordón A , Laguno M , Leal L , Rojas J , Torres B , Fernandez S , Tellez A , Fuentes F , Ayala M , Campubri D , de Alba M T , Fernandez M , Ferrer E , Grau B , Marti H , Muelas M , Pinazo M J , Rodriguez N , Roldan M , Subira C , Vera I , Williams N , Almuedo-Riera A , Muñoz J , Aldea A , Camafort M , Calvo J , Capdevila A , Cardellach F , Carbonell I , Coloma E , Foncillas A , Estruch R , Feliu M , Fernández-Solá J , Fuertes I , Gabara C , Grafia I , Ladino A , López-Alfaro R , López-Soto A , Macaya I , Masanés F , Matas A , Navarro M , Marco-Hernández J , Miguel L , Milisenda J C , Moreno P , Naval J , Nicolás D , Oberoi H , Padrosa J , Prieto-González S , Pellicé M , Ribot J , Rodríguez-Núnez O , Sacanella E , Seguí F , Sierra C , Tomé A , Torres M , Ventosa H , Zamora-Martínez C , Almela M , Alvarez M , Bosch J , Costa J , Cuesta G , Fidalgo B , Gonzàlez J , Marco F , Narvaez S , Pitart C , Rubio E , Vergara A , Valls M E , Zboromyrska Y 
Published: August 2021

Abstract

Background
The use of remdesivir has demonstrated a significant reduction in the time to recovery in patients with COVID-19. However, the impact on mortality is still controversial. Therefore, it is necessary to evaluate whether there is a specific subgroup of patients in whom an active antiviral therapy also reduces the mortality.

Methods
Patients admitted for &gt;48 h in our hospital for a SARS-CoV-2 confirmed or suspected infection from February 2020 to February 2021 were retrospectively analysed. The primary outcome of the study was mortality at 30 days. Univariate and multivariate analyses were performed to identify predictors of mortality.

Results
In total, 2607 patients (438 receiving remdesivir and 2169 not) were included with a median (IQR) age of 65 (54–77) years and 58% were male. Four hundred and seventy-six were admitted to the ICU (18.3%) and 264 required invasive mechanical ventilation (10.1%). The global 30 day mortality rate was 10.7%. Pre-admission symptom duration of 4–6 days and ≤3 days was associated with a 1.5- and 2.5-fold increase in the mortality rate, respectively, in comparison with &gt;6 days and treatment with remdesivir was independently associated with a lower mortality rate (OR = 0.382, 95% CI = 0.218–0.671). The analysis showed that the major difference was among patients with shorter pre-admission symptom duration (&lt;6 days).

Conclusions
Patients with ≤3 days and 4–6 days from symptom onset to admission are associated with a 2.5- and 1.5-fold higher risk of death, respectively. Remdesivir was associated with 62% reduced odds of death versus standard-of-care and its survival benefit increased with shorter duration of symptoms.