AUTHOR=Ramos-Rincón José Manuel , Pinargote-Celorio Héctor , Llenas-García Jara , Moreno-Pérez Oscar , González-Cuello Inmaculada , Gonzalez-de-la-Aleja Pilar , Martínez-López Belén , Reus Sergio , García-López María , Rodríguez Juan Carlos , Boix Vicente , Merino Esperanza 

TITLE=A retrospective real-world study of early short-course remdesivir in non-hospitalized COVID-19 patients at high risk for progression: low rate of hospitalization or death, regardless of immunocompetence status

JOURNAL=Frontiers in Pharmacology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2023.1218650

DOI=10.3389/fphar.2023.1218650

ISSN=1663-9812

ABSTRACT=Introduction: The evidence for remdesivir therapy in immunocompromised patients is scarce. To evaluated remdesivir (RDV) effectiveness and safety in COVID-19 outpatients at high risk for progression in a real-world setting. We compare the outcome in immunocompromised (IC) and with non-immunocompromised patients. 
Methods: Two hospitals retrospective study of all adult patients with mild-to-moderate SARS-CoV-2 infection at high risk for disease progression that were treated as out-patients with a 3-day course of RDV (1st January -30th September 2022). The primary effectiveness end point was a composite of any cause hospitalization or death by day 30. A Multiple logistic regression model was built to explore the association between immune status and clinical outcome, estimating adjusted odds ratios (aORs [95% CI]).
Results: We included 211 patients, 57% males, median age 65 years (IQR 53-77), 70.1% vaccinated (>2 doses) and 61.1% IC. The median duration of symptoms before RDV treatment was 3 days (IQR 2-5).  During follow up 14 (6.6%) were hospitalized, 6 (2.8%) for COVID-19 progression. No patient required mechanical ventilation, and two patients died (non-COVID19 related). After accounting for potential confounders, only anti-CD20 treatment was associated with the composed outcome (aOR 5.35[1.02-27.5, 95%CI]), whereas immunocompetence status was not (aOR 1.94[0.49-7.81, 95%CI]).
Conclusion: Early COVID-19 outpatient treatment with a 3-day course of remdesivir in vaccinated patients at high-risk for disease progression during Omicron surge had a good safety profile. It was associated with low rate of all-causes hospitalization or death, regardless of immunocompetence status.