Study Supports Use of Remdesivir for Covid Patients on Low-Flow Oxygen or No Oxygen

Johns Hopkins Medicine

The antiviral therapy reduced time to clinical improvement in patients not requiring high levels of respiratory support

Remdesivir, an antiviral drug used to treat COVID-19, increased the likelihood of clinical improvement in COVID-19 patients on low-flow oxygen or no oxygen, according to a new study authored by the Johns Hopkins University School of Medicine, the Johns Hopkins Bloomberg School of Public Health, HCA Healthcare, and Genospace.

The researchers analyzed data from over 43,000 patients hospitalized with COVID-19 and treated by HCA Healthcare. Patients who received remdesivir were matched to the most similar patients in a control group whose members were eligible for, but did not receive, remdesivir treatment. Overall, 74% of remdesivir-receiving patients saw improvement within 28 days (with a median time of seven days) versus 68.3% of control patients (with a median time of nine days).

In particular, remdesivir patients receiving low-flow oxygen treatment or no treatment with oxygen saw significantly greater clinical improvement than their control patient counterparts. Treatment with remdesivir also significantly reduced mortality in patients on low-flow oxygen, even when accounting for the effects of anti-inflammatory medications, such as dexamethasone. Of these patients on low-flow oxygen, the 28-day mortality rate of remdesivir recipients was 4.1% lower than that of the control patients.

“Our findings support the routine use of remdesivir in patients who are hospitalized with COVID-19,” says study lead author Brian Garibaldi, M.D., an associate professor of medicine at the Johns Hopkins University School of Medicine. “We observed that remdesivir is best used as early as possible, before the patient progresses to requiring high levels of oxygen or intubation and mechanical ventilation. Most patients who need that kind of advanced respiratory support are likely past the point where antiviral therapies like remdesivir would be effective.”

There have been several previous studies on remdesivir’s effectiveness in treating COVID-19 infection, and the results have often conflicted. However, the authors of this study have great confidence in their conclusions due to the diversity of the patients evaluated and the fact that this is one of the largest retrospective studies of remdesivir to date.

“This is an important, real-world study that shows remdesivir does work in many cases,” says Garibaldi. “Our findings are particularly important as we battle a surge of delta and omicron cases. By using remdesivir to shorten the length of the illness, we can free up hospital beds for COVID and non-COVID patients, and alleviate capacity issues across the country.”

The study was conducted as part of the COVID-19 Consortium of HCA Healthcare and Academia for Research Generation (CHARGE), a partnership between HCA Healthcare, the Agency for Healthcare Research and Quality, and 10 academic medical centers (including the Johns Hopkins University School of Medicine) across the United States. CHARGE uses data derived from HCA Healthcare’s vast clinical network that has cared for close to 200,000 U.S. patients hospitalized with COVID-19. This public-private partnership serves as a unique opportunity to learn about COVID-19, as well as a potential model for future big data collaborations that can drive discovery for numerous other diseases.

Conflict of interest disclosure about study’s authors:

  • Garibaldi is a member of the FDA’s Pulmonary-Asthma Drug Advisory Committee and has received consulting fees from Janssen Research and Development LLC, Gilead Life Sciences Inc., and Atea Pharmaceuticals Inc.
  • G. Caleb Alexander of the Johns Hopkins Bloomberg School of Public Health is past chair and a current member of the FDA’s Peripheral and Central Nervous System Advisory Committee; is a co-founding principal and equity holder in Monument Analytics, a health care consultancy whose clients include the life sciences industry as well as plaintiffs in opioid litigation; and is a past member of OptumRx’s National P&T Committee.
  • Kathleen Andersen and Corey Joseph, both of the Johns Hopkins Bloomberg School of Public Health, received doctoral training support from the National Heart, Lung and Blood Institute Pharmacoepidemiology T32 Training Program (T32HL139426-03).
  • Josh Betz and Robert Bollinger, both of the Johns Hopkins University School of Medicine, are entitled to equity and royalty payments from miDiagnostics. Bollinger is entitled to equity and royalty payments from emocha Health and is a consultant for Merck & Co, Hologic and Hip Hop Public Health.

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