Comparable Outcomes of Remdesivir and Nirmatrelvir/Ritonavir in High-Risk COVID-19 Patients


This study, presented at MAD-ID, The Antimicrobial Stewardship Meeting, evaluates patients with mild COVID-19 symptoms compared to those with severe cases.

COVID-19 Coronavirus cells

COVID-19 Coronavirus cells

Image credits: Unsplash

This shift in patient presentation prompts critical questions regarding the management of hospitalized COVID-19 patients, particularly those at risk of disease progression. 2 prior studies, PINETREE and EPIC-HR, explored treatment options for patients with mild to moderate disease in the outpatient setting, offering insights into inpatient management strategies.

Analysis of endpoints revealed comparable outcomes between the 2 treatment groups. The need for escalation to oxygen support occurred at similar rates in both the remdesivir (14%) and nirmatrelvir/ritonavir (N/R) (10%) groups, with no statistically significant difference observed (p=0.631). Mechanical ventilation was required by only 1 patient in the N/R group, with none in the remdesivir cohort (p=0.418). Additionally, parameters such as length of stay, 30-day COVID-related readmission, all-cause readmission at 30 days, and COVID-related mortality exhibited no significant variance between the groups.

The study comprised 165 patients, 96 receiving the 3-day remdesivir regimen and 69 treated with N/R. Baseline characteristics between the two groups exhibited similarity demonstrating relatively high Charlson Comorbidity Indexes, indicating a heightened likelihood of adverse outcomes related to COVID-19. Common risk factors included elevated BMI, hypertension, advanced age, and diabetes mellitus.

The study aimed to evaluate the efficacy of a 3-day course of remdesivir and N/R in high-risk patients hospitalized with asymptomatic or mild COVID-19. Conducted as a single-center, retrospective cohort study, from January 2021 to December 2023 and included adult patients meeting the specified criteria. Patients who had received additional COVID-19 therapies or were under treatment before hospitalization were excluded from the analysis.

In conclusion, the study suggests that hospitalized high-risk COVID-19 patients treated with either 3-day remdesivir or N/R experience similar rates of disease progression, length of stay, readmissions, and mortality. These findings contribute valuable insights into managing COVID-19 in the inpatient setting, offering potential avenues for optimizing patient care and outcomes amidst the evolving pandemic landscape.

More information from Contagion on PINETREE and EPIC-HR studies.

Belk M, Steuber T, Edwards J, et. al. Utilization of 3-day Remdesivir and Nirmatrelvir/ ritonavir for the Treatment of Asymptomatic and Mild COVID-19 in High Risk Hospitalized Patients. Abstract #37 OR presented MAD-ID The Antimicrobial Stewardship Meeting. May 8-11 Orlando, Florida.
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