Effectiveness of Early Remdesivir Initiation in Patients with Immunocompromising Conditions Hospitalized with COVID-19 by Variant Era, Level of Immunocompromise, and Age
Author(s)
Mark Berry, PhD1, EunYoung Lee, PharmD1, Valentina Shvachko, MS1, Carrie Nielson, ScD1, Kathleen Wirth Hurwitz, ScD2, Nuvan Rathnayaka, PhD2, Rachel W. Faller, PhD2, Mazin Abdelghany, MD1, M. Alan Brookhart, PhD2, Anand P. Chokkalingam, PhD1;
1Gilead Sciences, Inc., Foster City, CA, USA, 2Target RWE, Durham, NC, USA
1Gilead Sciences, Inc., Foster City, CA, USA, 2Target RWE, Durham, NC, USA
Presentation Documents
OBJECTIVES: This study aimed to determine whether early initiation of remdesivir in COVID-19 patients with immunocompromising conditions is associated with reduced mortality in subgroups stratified by COVID-19 variant era, level of immunocompromise, and age group.
METHODS: This was a retrospective observational cohort study using HealthVerity data, which includes linked US hospital chargemaster data and medical and pharmacy claims. Patients with immunocompromising conditions aged ≥12 years who were hospitalised between May 2020 and December 2023 with a primary diagnosis of COVID-19 were included. Patients who initiated remdesivir during the first two days of hospitalization were compared to those who received no remdesivir during the hospital stay. A clone-censor-weight design was used to calculate risk ratios for in-hospital mortality, controlling for baseline and time-varying confounders. Analyses were stratified by age group (12-64 or ≥65 years), variant era (initial wave, Delta, and Omicron), and degree of immunocompromise (mild or moderate/severe).
RESULTS: Overall, 39,315 patients had remdesivir during the first 2 days, and 53,471 did not receive remdesivir during their hospitalization. At 14 days after admission, the risk ratio (RR) of mortality was 0.68 (95% CI, 0.60-0.76) for early remdesivir treatment versus no treatment in patients aged 12-64 years, and 0.78 (95% CI, 0.74-0.81) in patients aged ≥65 years. Across variant eras, the risk was lower for the remdesivir treatment group (initial wave, 0.73 [95% CI, 0.68-0.78]; Delta, 0.81 [95% CI, 0.73-0.90]; Omicron, 0.81 [95% CI, 0.75-0.87]). The effect of remdesivir treatment was similar among moderately/severely immunocompromised patients (RR, 0.73 [95% CI, 0.66-0.81]) and among mildly immunocompromised patients (RR, 0.77 [95% CI, 0.74-0.81]).
CONCLUSIONS: Using methods that reduce bias due to time-varying confounding, informative censoring, and immortal person-time, this study found that the risk of in-hospital mortality was lower for patients who received early remdesivir, regardless of immunocompromise severity, variant era, and age.
METHODS: This was a retrospective observational cohort study using HealthVerity data, which includes linked US hospital chargemaster data and medical and pharmacy claims. Patients with immunocompromising conditions aged ≥12 years who were hospitalised between May 2020 and December 2023 with a primary diagnosis of COVID-19 were included. Patients who initiated remdesivir during the first two days of hospitalization were compared to those who received no remdesivir during the hospital stay. A clone-censor-weight design was used to calculate risk ratios for in-hospital mortality, controlling for baseline and time-varying confounders. Analyses were stratified by age group (12-64 or ≥65 years), variant era (initial wave, Delta, and Omicron), and degree of immunocompromise (mild or moderate/severe).
RESULTS: Overall, 39,315 patients had remdesivir during the first 2 days, and 53,471 did not receive remdesivir during their hospitalization. At 14 days after admission, the risk ratio (RR) of mortality was 0.68 (95% CI, 0.60-0.76) for early remdesivir treatment versus no treatment in patients aged 12-64 years, and 0.78 (95% CI, 0.74-0.81) in patients aged ≥65 years. Across variant eras, the risk was lower for the remdesivir treatment group (initial wave, 0.73 [95% CI, 0.68-0.78]; Delta, 0.81 [95% CI, 0.73-0.90]; Omicron, 0.81 [95% CI, 0.75-0.87]). The effect of remdesivir treatment was similar among moderately/severely immunocompromised patients (RR, 0.73 [95% CI, 0.66-0.81]) and among mildly immunocompromised patients (RR, 0.77 [95% CI, 0.74-0.81]).
CONCLUSIONS: Using methods that reduce bias due to time-varying confounding, informative censoring, and immortal person-time, this study found that the risk of in-hospital mortality was lower for patients who received early remdesivir, regardless of immunocompromise severity, variant era, and age.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EPH141
Topic
Epidemiology & Public Health
Topic Subcategory
Safety & Pharmacoepidemiology
Disease
SDC: Infectious Disease (non-vaccine)