Drug Design, Development and Therapy (Oct 2022)

Impact of Remdesivir on SARS-CoV-2 Clearance in a Real-Life Setting: A Matched-Cohort Study

  • Spagnuolo V,
  • Voarino M,
  • Tonelli M,
  • Galli L,
  • Poli A,
  • Bruzzesi E,
  • Racca S,
  • Clementi N,
  • Oltolini C,
  • Tresoldi M,
  • Rovere Querini P,
  • Dagna L,
  • Zangrillo A,
  • Ciceri F,
  • Clementi M,
  • Castagna A

Journal volume & issue
Vol. Volume 16
pp. 3645 – 3654

Abstract

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Vincenzo Spagnuolo,1 Marta Voarino,2 Marco Tonelli,2,3 Laura Galli,1 Andrea Poli,1 Elena Bruzzesi,2 Sara Racca,3 Nicola Clementi,2,3 Chiara Oltolini,1 Moreno Tresoldi,4 Patrizia Rovere Querini,2,5 Lorenzo Dagna,2,6 Alberto Zangrillo,2,7 Fabio Ciceri,2,8 Massimo Clementi,2,3 Antonella Castagna1,2 On behalf of the COVID-BioB Study Group1Unit of Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy; 2Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy; 3Unit of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy; 4General Medicine and Advanced Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; 5Internal Medicine, Diabetes, and Endocrinology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; 6Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; 7Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; 8Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, ItalyCorrespondence: Vincenzo Spagnuolo, Unit of Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy, Tel +390226437907, Fax +390226437903, Email [email protected]: Evidence regarding the impact of remdesivir (RDV) on SARS-CoV-2 viral clearance (VC) is scarce. The aim of this study was to compare VC timing in hospitalized COVID-19 patients who did or did not receive RDV.Methods: This was a matched-cohort study of patients hospitalized with pneumonia, a SARS-CoV-2-positive nasopharyngeal swab (NPS) at admission, and at least one NPS during follow-up. Patients who received RDV (cases) and those who did not (controls) were matched in a 1:2 ratio by age, sex, and PaO2/FiO2 (P/F) values at admission. NPSs were analyzed using real-time polymerase chain reaction. Time to VC (within 30 days after hospital discharge) was estimated using the Kaplan–Meier curve. A multivariable Cox proportional hazard model was fitted to determine factors associated with VC.Results: There were 648 patients enrolled in the study (216 cases and 432 controls). VC was observed in 490 patients (75.6%), with a median time of 25 (IQR 16– 34) days. Overall, time to VC was similar between cases and controls (p = 0.519). However, time to VC was different when considering both RDV treatment status and age (p = 0.007). A significant finding was also observed when considering both RDV treatment status and P/F values at admission (p = 0.007). A multivariate analysis showed that VC was associated with a younger age (aHR = 0.990, 95% CI 0.983– 0.998 per every 10-year increase in age; p = 0.009) and a higher baseline P/F ratio (aHR=1.275, 95% CI 1.029– 1.579; p=0.026), but not with RDV treatment status.Conclusion: Time to VC was similar in cases and controls. However, there was a benefit associated with using RDV in regard to time to VC in younger patients and in those with a P/F ratio ≤ 200 mmHg at hospital admission.Keywords: COVID-19, remdesivir, SARS-CoV-2, viral clearance

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