背景:在未接种疫苗的情况下进行的一项试验,delta期COVID-19高危门诊患者的住院率降低.我们使用我们的真实世界数据平台来确定雷米西韦在Omicron期间减少轻中度COVID-19门诊患者28天住院的有效性,包括BQ.1/BQ.1.1/XBB.1.5。
方法:我们进行了倾向匹配,2022年4月7日至2023年2月7日期间非住院成人SARS-CoV-2感染的回顾性队列研究.来自科罗拉多州大型卫生系统的电子医疗记录数据与全州疫苗接种和死亡率数据相关联。我们纳入了SARS-CoV-2测试阳性或门诊患者remdesivir。排除标准是其他SARS-CoV-2治疗或SARS-CoV-2试验阳性超过7天。主要结果是直到第28天的全因住院。次要结局包括28天COVID相关住院和28天全因死亡率。
结果:在29,270例SARS-CoV-2感染患者中,1,252名接受雷德西韦治疗的患者与2,499名未经治疗的患者相匹配。Remdesivir与较低的28天全因住院相关(1.3%与3.3%,调整后的风险比(AHR)0.39[95%CI0.23-0.67],p<0.001)比没有治疗。在接受remdesivir治疗的患者中,28天时的全因死亡率在数值上较低(0.1%vs.0.4%;OR0.32[95%CI0.03-1.40])。在Omicron期间观察到RDV治疗28天全因住院的类似益处,OR(95%CI):BA.2/BA2.12.1(0.77[0.19-2.41]),BA4/5(0.50[95%CI0.50-1.01]),BQ.1/BQ.1.1/XBB.1.5(0.21[95%CI0.08-0.57]。
结论:在最近的Omicron激增期间,在SARS-CoV-2门诊患者中,remdesivir的住院率低于不治疗,支持当前的美国国立卫生研究院指南。
BACKGROUND: A trial performed among unvaccinated, high-risk outpatients with COVID-19 during the delta period showed remdesivir reduced hospitalization. We used our real-world data platform to determine the effectiveness of remdesivir on reducing 28-day hospitalization among outpatients with mild-moderate COVID-19 during an Omicron period including BQ.1/BQ.1.1/XBB.1.5.
METHODS: We did a propensity-matched, retrospective cohort study of non-hospitalized adults with SARS-CoV-2 infection between April 7, 2022, and February 7, 2023. Electronic healthcare record data from a large health system in Colorado were linked to statewide vaccination and mortality data. We included patients with a positive SARS-CoV-2 test or outpatient remdesivir administration. Exclusion criteria were other SARS-CoV-2 treatments or positive SARS-CoV-2 test more than seven days before remdesivir. The primary outcome was all-cause hospitalization up to day 28. Secondary outcomes included 28-day COVID-related hospitalization and 28-day all-cause mortality.
RESULTS: Among 29,270 patients with SARS-CoV-2 infection, 1,252 remdesivir-treated patients were matched to 2,499 untreated patients. Remdesivir was associated with lower 28-day all-cause hospitalization (1.3% vs. 3.3%, adjusted hazard ratio (aHR) 0.39 [95% CI 0.23-0.67], p < 0.001) than no treatment. All-cause mortality at 28 days was numerically lower among remdesivir-treated patients (0.1% vs. 0.4%; aOR 0.32 [95% CI 0.03-1.40]). Similar benefit of RDV treatment on 28-day all-cause hospitalization was observed across Omicron periods, aOR (95% CI): BA.2/BA2.12.1 (0.77[0.19-2.41]), BA.4/5 (0.50[95% CI 0.50-1.01]), BQ.1/BQ.1.1/XBB.1.5 (0.21[95% CI 0.08-0.57].
CONCLUSIONS: Among outpatients with SARS-CoV-2 during recent Omicron surges, remdesivir was associated with lower hospitalization than no treatment, supporting current National Institutes of Health Guidelines.