P-1632. Effectiveness of remdesivir in patients with underlying hepatic or renal comorbidity hospitalized for SARS-CoV-2 infection

TL;DR

This study shows that remdesivir reduces in-hospital mortality for patients with SARS-CoV-2 and underlying liver or kidney conditions.

Contribution

The study provides new evidence on remdesivir's effectiveness in high-risk patients with hepatic or renal comorbidities.

Findings

Remdesivir reduced mortality risk in patients with renal comorbidities (HR 0.85) and hepatic comorbidities (HR 0.67).

Patients with hepatic comorbidities not requiring oxygen had a 45% lower mortality risk with remdesivir.

The benefit was observed even in more severely ill patients requiring supplemental oxygen.

Abstract

Individuals infected with SARS-CoV-2 with underlying hepatic or renal comorbidities are at higher mortality risk than the overall population. Antiviral treatment with remdesivir (RDV) in individuals hospitalized for SARS-CoV-2 has been shown to reduce in-hospital mortality across many high-risk groups, regardless of COVID-19 severity and variant era. Data on the effect of early RDV treatment in these high-risk subpopulations are needed to inform clinical decision-making.

This retrospective study of U.S. medical claims and hospital chargemaster data examined the effectiveness of initiating RDV upon hospital admission, in the first 2 days, on all-cause mortality or discharge to hospice among adults hospitalized for SARS-CoV-2 infection with pre-existing hepatic or renal comorbidity, vs no RDV treatment in the first 2 days. Patients were followed for up to 30 days, until discharge, or death, whichever occurred first. Coarsened exact matching and 1:1 propensity score (PS) matching were based on demographic, clinical, and hospital characteristics. Mortality risk was compared via Cox proportional hazard ratio (HR) and 95% confidence interval (CI). Analysis was stratified by supplemental oxygen (O2) support received during the baseline, in the first 2 days.

The 1:1 PS-matched renal cohort included 13,798 patients (mortality, 6.05%; Table 1) ; the 1:1 PS-matched hepatic cohort included 4,968 patients (mortality, 4.59%; Table 2). Remdesivir use was associated with lower risk of in-hospital mortality in each cohort overall—renal 0.85 (95% CI 0.75, 0.96), hepatic 0.67 (0.53, 0.85)—as well as among more severely ill patients in each cohort requiring supplemental O2 upon admission: renal 0.79 (0.69, 0.91), hepatic 0.73 (0.56, 0.95). Hepatic patients who did not require supplemental O2 also had significantly lower mortality risk: 0.55 (0.34, 0.89). Mortality risk reduction in renal patients not requiring supplemental O2 was not statistically significant: 0.87 (0.68, 1.11).

Individuals hospitalized with SARS-CoV-2 infection with underlying hepatic or renal comorbidity treated with RDV realized in-hospital survival benefit over those not similarly treated, both overall and in severely ill patients receiving supplemental O2.

Patrick Godwin, MD, Gilead Sciences, Inc.: Advisor/Consultant|Gilead Sciences, Inc.: advisory board, speakers bureau John Jay Hawkshead, DrPH, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Valentina Shvachko, MS, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Thomas F. Oppelt, PharmD, BCPS, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Chen-Yu Wang, PhD, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Essy Mozaffari, PharmD, MPH, MBA, Gilead Sciences, Inc.: Former Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Amos Lichtman, MPH, MD, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Mark Berry, PhD, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company)

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