Dual therapy with dexamethasone plus remdesivir is associated with reduced risk of mortality in patients hospitalized with COVID-19 infection, according to study results presented at the Conference on Retroviruses and Opportunistic Infections (CROI) 2024, held from March 3 to 6, in Denver, Colorado.
Researchers conducted a study to compare the effectiveness of dexamethasone plus remdesivir with dexamethasone monotherapy in patients hospitalized with COVID-19 infection during the Omicron period (December 2021-April 2023). Eligible patients included adults who initiated either dual therapy or monotherapy within the first 2 days of admission. The researchers used 1:1 propensity score matching to compare outcomes between the treatment groups and inverse probability of treatment weighting to estimate the effectiveness of dual therapy in the full cohort. A Cox proportional hazards model was constructed to examine the risk of 14- and 28-day mortality.
Patients were categorized by baseline supplemental oxygen status, including those who required no supplemental oxygen (NSOc); low-flow oxygen (LFO); high-flow oxygen/noninvasive ventilation (HFO/NIV); or invasive mechanical ventilation/extracorporeal membrane oxygenation (IMV/ECMO).
In total, there were 151,215 patients included in the analysis, of whom 40% were in the dual therapy group and 24% were in the monotherapy group. The matched analysis comprised 33,089 patients in each treatment group.
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The effectiveness of RDV+DEX in reducing mortality compared to DEX monotherapy was confirmed through two well-established methods of addressing confounding by indication bias…
Between-group analysis showed that the risk of 14-day mortality was significantly lower among patients who received dual therapy with dexamethasone plus remdesivir, regardless of oxygenation requirement.
- NSoc (adjusted hazard ratio [aHR], 0.75; 95% CI, 0.68-0.83; P <.001);
- LFO (aHR, 0.70; 95% CI, 0.64-0.77; P <.001);
- HFO/NIV (aHR, 0.71; 95% CI, 0.64-0.79; P <.001); and
- IMV/ECMO (aHR, 0.82; 95% CI, 0.70-0.97; P =.05).
Further analysis showed that the risk of 28-day mortality was also lower among patients who received dual therapy. Moreover, consistent results were observed via inverse probability of treatment weighting.
According to the researchers, “The effectiveness of RDV+DEX [remdesivir plus dexamethasone] in reducing mortality compared to DEX monotherapy was confirmed through two well-established methods of addressing confounding by indication bias…”
This article originally appeared on Infectious Disease Advisor.
References:
Mozaffari E, Chandak A, Gottlieb RL, et al. Remdesivir+dexamethasone for the treatment of COVID-19: real-world study in the US. Presented at: CROI 2024; March 3-6; Denver, CO. Abstract 665.
