The Perfect Enemy | Remdesivir, steroids tied to better COVID hospital outcomes
October 31, 2023

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.