Work

Combination therapy with remdesivir and immunomodulators improves respiratory status in COVID‐19: A retrospective study

Year: 2022

Type: article

Abstract: Background: Although immunomodulators (tocilizumab or baricitinib) have been shown to improve outcomes in patients with coronavirus disease (COVID-19), the additive effect of remdesivir is unknown. We retrospectively tested the effect of remdesivir in combination with immunomodulators and standard treatments in COVID-19 patients.Methods: A retrospective, single-center study was conducted on patients with COVID-19 admitted to the Hokkaido University Hospital between April 2020 and September 2021, who were treated with either tocilizumab or baricitinib. The duration to achievement of oxygen-free in both groups was compared, and the effect of remdesivir use on respiratory status was examined through multivariate analysis. The severity of respiratory status in the two groups on day 14 and day 28 was compared. A sensitivity analysis using propensity score was also performed.Results: We enrolled 98 patients who received either tocilizumab or baricitinib. Of these, 72 patients used remdesivir (remdesivir group) and 26 did not (control group). Most cases were severe and treated with concomitant steroids. The remdesivir group had faster recovery of respiratory status compared to the control group (11 days vs. 26 days, P=0.033). Multivariate analysis showed that remdesivir use contributed to shorter time to being oxygen-free (hazard ratio [HR] = 2.33, 95 % confidence interval [CI] 1.17 – 4.46, P=0.016). Age, body mass index, diabetes mellitus, and time from onset to oxygen administration were independent prognostic factors. The remdesivir group achieved higher rate of oxygen free than the control group at days 14 and 28 after treatment (P=0.033, P=0.003, respectively). The degree of improvement from baseline severity was also higher in the remdesivir group (day 14; P=0.047, day 28; P=0.018). The survival time between two groups was not significantly different (HR = 0.55, 95 %CI 0.10 – 2.99, P=0.49). Similarly, the propensity score-matched patient groups showed the efficacy of remdesivir. Conclusions: Among patients with COVID-19 who used immunomodulator containing tocilizumab or baricitiib, remdesivir contributed to shorter respiratory recovery time and better respiratory status at days 14 and 28. Concomitant use of remdesivir may contribute to improved respiratory status in patients on immunomodulator and standard treatment.

Source: Journal of Medical Virology

DOI: 10.1002/jmv.28037