Study Shows Routine Use of Remdesivir for COVID-19 May Increase Length of Hospital Stay without Improving Survival
Remdesivir was one of the first drugs studied for treating people with COVID-19, but randomized trials have produced conflicting results about its efficacy and conflicting recommendations regarding its use. This retrospective cohort study sought to determine any associations between remdesivir treatment, survival, and length of stay among Veterans hospitalized with COVID-19 in the VA healthcare system. The primary objective was to determine the association between remdesivir receipt and all-cause 30-day mortality, in addition to assessing time to hospital discharge. Study investigators identified Veterans diagnosed with COVID-19 who had a first hospitalization at any of 123 VA hospitals between May and October 2020 (n=5,898). Propensity score matching was then used to create an analytic cohort of 1,172 Veterans who received remdesivir and 1,172 who did not. Risk adjustment variables included demographics, mechanical ventilation, ICU admission, laboratory values (i.e., serum creatinine, total white blood cell count), vital signs (i.e., temperature, blood pressure, respiratory rate, and arterial oxygen saturation), outpatient medications prior to admission, inpatient medications, admission month, and comorbidities prior to admission.
- Among Veterans in this study, remdesivir therapy was not associated with improved 30-day survival: 12% mortality for remdesivir recipients vs. 11% for those who did not receive remdesivir.
- Remdesivir therapy was associated with an increase in median time to hospital discharge: 6 days for Veterans who received remdesivir compared to 3 days for matched Veterans who did not receive the drug.
- Examination of time to remdesivir completion and discharge suggested that clinicians may have been keeping patients in the hospital to complete 5-day remdesivir courses, contributing to a longer length of stay.
- Remdesivir treatment was not associated with survival but was associated with longer hospitalization, suggesting that the routine use of remdesivir may be utilizing scarce hospital beds during a pandemic without leading to clear improvements in patient survival, and that interventions are needed to ensure that patients are not kept in the hospital solely to receive remdesivir.
- In all observational studies there is potential for unadjusted confounding related to illness severity.
- Residual differences in illness severity could obscure improvements in survival and explain longer length of hospital stay among remdesivir recipients compared to Veterans in the control group.
This study was funded by HSR&D (C19 20-204). Drs. Ohl and Lund are part of HSR&D’s Center for Access & Deliver Research and Evaluation (CADRE) in Iowa City, IA.
Ohl M, Miller D, Lund B, et al. Association of Remdesivir Treatment with Survival and Length of Hospital Stay among US Veterans Hospitalized with COVID-19. JAMA Network Open. July 15, 2021;4(7):e2114741.