PDF(Pubmed)
Abstract：
Remdesivir (REM) and monoclonal antibodies (mAbs) could alleviate severe COVID-19 in at-risk outpatients. However, data on their use in hospitalized patients, particularly in elderly or immunocompromised hosts, are lacking.
All consecutive patients hospitalized with COVID-19 at our unit from 1 July 2021 to 15 March 2022 were retrospectively enrolled. The primary outcome was the progression to severe COVID-19 (P/F < 200). Descriptive statistics, a Cox univariate-multivariate model, and an inverse probability treatment-weighted (IPTW) analysis were performed.
Overall, 331 subjects were included; their median (q1-q3) age was 71 (51-80) years, and they were males in 52% of the cases. Of them, 78 (23%) developed severe COVID-19. All-cause in-hospital mortality was 14%; it was higher in those with disease progression (36% vs. 7%, p < 0.001). REM and mAbs resulted in a 7% (95%CI = 3-11%) and 14% (95%CI = 3-25%) reduction in the risk of severe COVID-19, respectively, after adjusting the analysis with the IPTW. In addition, by evaluating only immunocompromised hosts, the combination of REM and mAbs was associated with a significantly lower incidence of severe COVID-19 (aHR = 0.06, 95%CI = 0.02-0.77) when compared with monotherapy.
REM and mAbs may reduce the risk of COVID-19 progression in hospitalized patients. Importantly, in immunocompromised hosts, the combination of mAbs and REM may be beneficial.
All consecutive patients hospitalized with COVID-19 at our unit from 1 July 2021 to 15 March 2022 were retrospectively enrolled. The primary outcome was the progression to severe COVID-19 (P/F < 200). Descriptive statistics, a Cox univariate-multivariate model, and an inverse probability treatment-weighted (IPTW) analysis were performed.
Overall, 331 subjects were included; their median (q1-q3) age was 71 (51-80) years, and they were males in 52% of the cases. Of them, 78 (23%) developed severe COVID-19. All-cause in-hospital mortality was 14%; it was higher in those with disease progression (36% vs. 7%, p < 0.001). REM and mAbs resulted in a 7% (95%CI = 3-11%) and 14% (95%CI = 3-25%) reduction in the risk of severe COVID-19, respectively, after adjusting the analysis with the IPTW. In addition, by evaluating only immunocompromised hosts, the combination of REM and mAbs was associated with a significantly lower incidence of severe COVID-19 (aHR = 0.06, 95%CI = 0.02-0.77) when compared with monotherapy.
REM and mAbs may reduce the risk of COVID-19 progression in hospitalized patients. Importantly, in immunocompromised hosts, the combination of mAbs and REM may be beneficial.
摘要：
背景：Remdesivir（REM）和单克隆抗体（mAb）可以缓解有风险门诊患者的严重COVID-19。然而,关于他们在住院患者中使用的数据，特别是在老年人或免疫受损的宿主中，缺乏。
方法：回顾性纳入2021年7月1日至2022年3月15日在我们病房接受COVID-19治疗的所有连续患者。主要结果是进展为重度COVID-19（P/F<200）。描述性统计，Cox单变量-多变量模型，并进行了逆概率治疗加权(IPTW)分析.
结果：总体而言，包括331名受试者；他们的中位年龄（q1-q3）为71（51-80）岁，52%的病例是男性。其中,78人（23%）发展为严重的COVID-19。全因住院死亡率为14%；在疾病进展的人群中，死亡率更高(36%vs.7%,p<0.001)。REM和单克隆抗体分别使严重COVID-19的风险降低7%(95CI=3-11%)和14%(95CI=3-25%)，在用IPTW调整分析后。此外,通过仅评估免疫受损的宿主，与单药治疗相比,REM和mAb联合治疗与重度COVID-19的发生率显著降低相关(aHR=0.06,95CI=0.02~0.77).
结论：REM和mAb可降低住院患者COVID-19进展的风险。重要的是,在免疫受损的宿主中，mAb和REM的组合可能是有益的。
方法：回顾性纳入2021年7月1日至2022年3月15日在我们病房接受COVID-19治疗的所有连续患者。主要结果是进展为重度COVID-19（P/F<200）。描述性统计，Cox单变量-多变量模型，并进行了逆概率治疗加权(IPTW)分析.
结果：总体而言，包括331名受试者；他们的中位年龄（q1-q3）为71（51-80）岁，52%的病例是男性。其中,78人（23%）发展为严重的COVID-19。全因住院死亡率为14%；在疾病进展的人群中，死亡率更高(36%vs.7%,p<0.001)。REM和单克隆抗体分别使严重COVID-19的风险降低7%(95CI=3-11%)和14%(95CI=3-25%)，在用IPTW调整分析后。此外,通过仅评估免疫受损的宿主，与单药治疗相比,REM和mAb联合治疗与重度COVID-19的发生率显著降低相关(aHR=0.06,95CI=0.02~0.77).
结论：REM和mAb可降低住院患者COVID-19进展的风险。重要的是,在免疫受损的宿主中，mAb和REM的组合可能是有益的。
