Association of remdesivir treatment with long-term mortality after COVID-19 hospitalization.

BACKGROUND

Effectiveness of remdesivir (RDV) treatment on short-term mortality and other outcomes has been well-studied, yet the impact of RDV on long-term outcomes is less well-known. The objective of this study was to determine if inpatient RDV use in survivors of COVID-19 hospitalization is associated with reduced mortality after discharge.

METHODS

This is a retrospective observational cohort study of patients hospitalized with COVID-19 between November 2020 and October 2022 in three health systems in Colorado and Utah. Real-world data were identified from electronic health records and state-level vaccination and mortality records. Our primary cohort were patients hospitalized with COVID-19, either treated or not treated with RDV, who survived to hospital discharge. Unadjusted and adjusted Cox proportional hazard models were used to estimate the hazard ratio of all-cause mortality following hospital discharge for those administered vs. not administered inpatient RDV. Sensitivity analyses included propensity-matching the primary cohort with in-hospital mortality as a competing risk. Secondary outcomes, including hospital and ED readmissions respectively, within 28 days after index hospitalization discharge, were also evaluated using Cox proportional hazard models.

RESULTS

The primary cohort consisted of 9760 patients who survived index hospitalization and had between 6 and 29 months of post-hospital follow up. Of the primary cohort, 4771 (48.8%) were treated with inpatient RDV, inpatient RDV was associated with a decreased mortality hazard (aHR 0.73; 95% confidence interval (CI) 0.61-0.87) among survivors with up to two and a half years of follow-up. Results from a sensitivity analysis using in-hospital mortality as a competing risk were similar to the primary model (aHR 0.76; CI 0.63-0.92). RDV treatment was also associated with decreased re-hospitalization (aHR 0.77; CI 0.67-0.89) and ED readmission rates (aHR 0.79; CI 0.67-0.92). Most subgroups appear to benefit from RDV, with possible exceptions for patients infected during the first Omicron wave, having received at least 1 vaccine dose, and those not requiring supplemental oxygen during index hospitalization.

CONCLUSIONS

In this real-world analysis of three large health systems in Colorado and Utah, RDV use was associated with decreased long-term mortality among survivors of initial COVID-19 hospitalization. Inpatient RDV treatment may provide a mortality benefit after COVID-19 hospitalization.