Treatment effect of remdesivir on the mortality of hospitalised COVID-19 patients in Switzerland across different patient groups: a tree-based model analysis.
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BORIS DOI
Date of Publication
August 28, 2023
Publication Type
Article
Division/Institute
Author
Estill, Janne | |
Venkova-Marchevska, Plamenna | |
Günthard, Huldrych F | |
Botero-Mesa, Sara | |
Thiabaud, Amaury | |
Roelens, Maroussia | |
Vancauwenberghe, Laure | |
Heininger, Ulrich | |
Iten, Anne | |
Schreiber, Peter W | |
Tschudin-Sutter, Sarah | |
Troillet, Nicolas | |
Vuichard-Gysin, Danielle | |
Widmer, Andreas | |
Hothorn, Torsten | |
Keiser, Olivia |
Subject(s)
Series
Swiss medical weekly
ISSN or ISBN (if monograph)
1424-3997
Publisher
SMW supporting association
Language
English
Publisher DOI
PubMed ID
37769356
Description
AIMS OF THE STUDY
Remdesivir has shown benefits against COVID-19. However, it remains unclear whether, to what extent, and among whom remdesivir can reduce COVID-19-related mortality. We explored whether the treatment response to remdesivir differed by patient characteristics.
METHODS
We analysed data collected from a hospital surveillance study conducted in 21 referral hospitals in Switzerland between 2020 and 2022. We applied model-based recursive partitioning to group patients by the association between treatment levels and mortality. We included either treatment (levels: none, remdesivir within 7 days of symptom onset, remdesivir after 7 days, or another treatment), age and sex, or treatment only as regression variables. Candidate partitioning variables included a range of risk factors and comorbidities (and age and sex unless included in regression). We repeated the analyses using local centring to correct the results for the propensity to receive treatment.
RESULTS
Overall (n = 21,790 patients), remdesivir within 7 days was associated with increased mortality (adjusted hazard ratios 1.28-1.54 versus no treatment). The CURB-65 score caused the most instability in the regression parameters of the model. When adjusted for age and sex, patients receiving remdesivir within 7 days of onset had higher mortality than those not treated in all identified eight patient groups. When age and sex were included as partitioning variables instead, the number of groups increased to 19-20; in five to six of those branches, mortality was lower among patients who received early remdesivir. Factors determining the groups where remdesivir was potentially beneficial included the presence of oncological comorbidities, male sex, and high age.
CONCLUSIONS
Some subgroups of patients, such as individuals with oncological comorbidities or elderly males, may benefit from remdesivir.
Remdesivir has shown benefits against COVID-19. However, it remains unclear whether, to what extent, and among whom remdesivir can reduce COVID-19-related mortality. We explored whether the treatment response to remdesivir differed by patient characteristics.
METHODS
We analysed data collected from a hospital surveillance study conducted in 21 referral hospitals in Switzerland between 2020 and 2022. We applied model-based recursive partitioning to group patients by the association between treatment levels and mortality. We included either treatment (levels: none, remdesivir within 7 days of symptom onset, remdesivir after 7 days, or another treatment), age and sex, or treatment only as regression variables. Candidate partitioning variables included a range of risk factors and comorbidities (and age and sex unless included in regression). We repeated the analyses using local centring to correct the results for the propensity to receive treatment.
RESULTS
Overall (n = 21,790 patients), remdesivir within 7 days was associated with increased mortality (adjusted hazard ratios 1.28-1.54 versus no treatment). The CURB-65 score caused the most instability in the regression parameters of the model. When adjusted for age and sex, patients receiving remdesivir within 7 days of onset had higher mortality than those not treated in all identified eight patient groups. When age and sex were included as partitioning variables instead, the number of groups increased to 19-20; in five to six of those branches, mortality was lower among patients who received early remdesivir. Factors determining the groups where remdesivir was potentially beneficial included the presence of oncological comorbidities, male sex, and high age.
CONCLUSIONS
Some subgroups of patients, such as individuals with oncological comorbidities or elderly males, may benefit from remdesivir.
File(s)
| File | File Type | Format | Size | License | Publisher/Copright statement | Content | |
|---|---|---|---|---|---|---|---|
| smw-2023-40095.pdf | text | Adobe PDF | 3.67 MB | published |