Background Remdesivir has demonstrated benefit in some hospitalized patients with COVID-19 on supplemental oxygen and in non-hospitalized patients at room air. The durability of this benefit across time periods with different circulating SARS-CoV-2 variants of concern (VOC) is unknown. This comparative effectiveness study compares inpatient mortality among patients hospitalized for COVID-19 not receiving supplemental oxygen at admission initiating remdesivir treatment in the first two days of admission vs. no remdesivir during the hospitalization across different VOC periods. Method Using a large, multicenter US hospital database, in-hospital mortality was compared among patients hospitalized for COVID-19 not requiring supplemental oxygen at admission between December 2020 and April 2022. Patients receiving remdesivir upon hospital admission were matched 1:1 to those not receiving remdesivir during hospitalization using propensity score matching. Cox proportional hazards models were used to assess 14- and 28-day in-hospital mortality or discharge to hospice. Results Among the 121,336 eligible patients, 58,188 remdesivir-treated patients were matched to 17,574 unique non-remdesivir patients. Overall, 5.4% of remdesivir-treated and 7.3% of non-remdesivir patients died within 14 days, while 8.0% of remdesivir-treated and 9.8% of non-remdesivir patients died within 28 days. Remdesivir treatment was associated with a statistically significant reduction in in-hospital mortality compared to non-remdesivir treatment (14-day adjusted hazard ratio (aHR): 0.75, 95% confidence interval (CI): 0.68-0.83; 28-day aHR: 0.83, 0.76-0.90). This significant mortality benefit endured across the different VOC periods. Conclusions Remdesivir initiation in patients hospitalized for COVID-19, not requiring supplemental oxygen at admission, was associated with a statistically significant reduction in in-hospital mortality. These findings highlight a potential survival benefit when clinicians initiated remdesivir upon admission across the dominant variant eras of the evolving pandemic.

中文翻译：

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瑞德西韦可降低因 COVID-19 住院且无需吸氧的患者的死亡率

背景 瑞德西韦已证明对一些接受补充氧气的住院 COVID-19 患者和使用室内空气的非住院患者有益处。对于不同的流行 SARS-CoV-2 变异体 (VOC)，这种益处在不同时间段内的持久性尚不清楚。这项比较有效性研究比较了因 COVID-19 住院且入院前两天未接受补充供氧且在入院前两天开始瑞德西韦治疗的患者与住院期间未接受瑞德西韦治疗的患者在不同 VOC 期间的住院死亡率。方法 使用美国大型多中心医院数据库，对 2020 年 12 月至 2022 年 4 月期间因 COVID-19 住院且入院时不需要补充氧气的患者的院内死亡率进行比较。入院时接受瑞德西韦治疗的患者与不需要补充氧气的患者进行 1:1 匹配。使用倾向评分匹配在住院期间接受瑞德西韦。 Cox 比例风险模型用于评估 14 天和 28 天的住院死亡率或出院到临终关怀中心的情况。结果 在 121,336 名符合条件的患者中，58,188 名接受瑞德西韦治疗的患者与 17,574 名未接受瑞德西韦的患者相匹配。总体而言，接受瑞德西韦治疗的患者和未接受瑞德西韦治疗的患者中有 5.4% 和 7.3% 在 14 天内死亡，而接受瑞德西韦治疗的患者和未接受瑞姆昔韦治疗的患者中有 8.0% 和 9.8% 在 28 天内死亡。与非瑞德西韦治疗相比，瑞德西韦治疗可显着降低院内死亡率（14 天调整后风险比 (aHR)：0.75，95% 置信区间 (CI)：0.68-0.83；28 天 aHR： 0.83、0.76-0.90）。这种显着的死亡率改善在不同的 VOC 时期都持续存在。结论 因 COVID-19 住院的患者开始使用瑞德西韦（入院时不需要补充氧气）与院内死亡率的统计显着降低相关。这些发现强调了当临床医生在入院时在流行病演变的主要变异时代开始使用瑞德西韦时，可能会带来潜在的生存获益。