1155. Short vs. Long Symptom Duration Prior to Remdesivir for Hospitalized Patients with COVID-19
Authors: Elshaboury Ramy H , Adamsick Meagan L , Huang Joanne , Winkler Marisa , Ghebremichael Musie , Cheung Fiona , Polsonetti Bryan , Mozaffari Essy , Chen Linda , Juelg Boris , Hohmann Elizabeth 
Published: December 2022

Abstract

Background
Remdesivir (RDV) has been a mainstay of COVID-19 therapy for hospitalized patients. Impact of RDV timing in relationship to symptom-onset in hospitalized patients remains unclear, though early treatment is theorized to improve antiviral activity and clinical outcomes.

Methods
This was a single-center retrospective study of adult patients hospitalized for severe COVID-19 treated with RDV. Patient charts were reviewed by 2 independent investigators to determine disease course and outcomes. Patients were stratified based on time from symptom-onset to RDV (short: ≤7 vs. long: &gt;7 days). The primary outcome was time to clinical recovery within 28 days. Secondary outcomes were proportion of patients recovered and proportion discharged from the hospital within 10, 14, and 28 days; and mortality within 28 days. Time to recovery was analyzed using the Kaplan-Meier method and the significance was tested by log rank tests. Cox’s proportional hazards models were used to estimate hazard ratios (HR). Fisher’s exact test was used to compare recovery rates between groups.

Results
Overall, 405 patient charts were reviewed, and 337 met the inclusion criteria. On the first day of RDV, 178 (53%) of patients had symptoms for &lt;7 days, while 159 (47%) of patients had symptoms for &gt;7 days. Patients in the short symptom duration group were slightly older (66.5 vs. 59 years, p=0.004) and had more co-morbidities. Median time to recovery was 7 (95% CI 5-9) in the short- vs. 5 (95% CI 4-6) days in the long-symptom duration groups, respectively, p=0.066. By day 10, 111 (62%) vs. 116 (73%) patients met the clinical recovery definition (p=0.048), and 113 (63%) vs. 119 (75%) patients were discharged from the hospital (p=0.026) in the short- vs. long-symptom duration groups, respectively. In the Cox’s proportional hazards model, age, disease severity, and co-morbidities (kidney, liver, chronic respiratory diseases, and type II diabetes mellitus) were associated with longer recovery times.

Conclusion
In this cohort, long duration of symptoms ( &gt;7 days) prior to initiation of RDV therapy was not associated with longer recovery time or longer hospitalization. Additional studies are needed to elucidate benefits of RDV therapy in relationship to the time course of severe COVID-19 in hospitalized patients.

Disclosures
Ramy H. Elshaboury, PharmD, Eli Lilly: Honoraria|Gilead Sciences: Grant/Research Support Fiona Cheung, PharmD, Pfizer Inc.: Employee Bryan Polsonetti, PharmD, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds Essy Mozaffari, PharmD, MPH, MBA, Gilead: Employee|Gilead: Stocks/Bonds Linda Chen, MPH, Gilead Sciences: Employee|Gilead Sciences: Stocks/Bonds|UCB pharmaceuticals: Stocks/Bonds Elizabeth Hohmann, MD, Gilead: Advisor/Consultant|Kowa Pharmaceuticals: Advisor/Consultant|Tend, Inc: Grant/Research Support.