Clinical characteristics and outcomes of hospitalized coronavirus disease 2019 patients treated with remdesivir in Saudi Arabia: A 1-year retrospective study

Abstract

Background: The recent pandemic caused by coronavirus disease 2019 (COVID-19) has resulted in increased deaths globally, and effective treatment is crucial as a form of disease management. Aims: This study was aimed to describe the epidemiological characteristics and outcomes of hospitalized COVID-19 patients who have been administered with remdesivir (RDV) at King Faisal Specialized Hospital in Saudi Arabia. Methods: Hospitalized COVID-19 adult patients who received RDV therapy (from January to December 2021) were included in this retrospective case series. Patients' demographics, medical history, presenting symptoms, and laboratory results were collected. Statistical analyses were performed using the Statistical Packages for the Social Sciences and data were presented based on their statistical variables. Results: A total of 210 patients (56.1% females, 43.9% males) with a mean ± standard deviation (SD) age of 57.43 ± 18.4 years were included in our analysis. Pneumonia was manifested in 52.4% of patients. The most common associated comorbidities were hypertension (54.76%) and diabetes (44.76%). From 180 participants that were vaccinated, 73 and 90 patients received two or three COVID-19 vaccine doses, respectively. The most frequent presenting symptoms were fever (80.1%) and cough (62.6%). About 48.1% and 10.48% of the cohort received RDV with dexamethasone or tocilizumab, respectively. Overall, 45.71% of the patients needed oxygen therapy during hospitalization, and 21 patients with pneumonia required mechanical ventilation for a mean ± SD of 15.15 ± 16.46 days with the mean ± SD length of the hospital stay which was 14.9 ± 46.29 days. Moreover, 41 patients were admitted to the intensive care unit for a mean ± SD stay of 10.5 ± 11.05 days, and 26 patients had died. Conclusion: Despite previous vaccination, a significant portion of hospitalized COVID-19 patients in our cohort required oxygen therapy and experienced longer periods of hospital stay, highlighting the seriousness of COVID-19 infection for some patients regardless of vaccination status. Relevance for patients: This study highlights RDV's role in reducing oxygen need and hospitalization duration, aiding better outcomes for COVID-19 patients.

Keywords

Coronavirus disease-2019 / Remdesivir / Saudi Arabia / Vaccination / Intensive care unit

Funding

Gilead Sciences Ireland UC funded the medical writing of this manuscript.

Conflict of interest

The authors declare that they have no competing interests.

References

[1] Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020; 323:1061-1069. doi: 10.1001/jama.2020.1585

[2] World Health Organization: WHO Coronavirus (COVID-19) Dashboard.Available from: https://data.who.int/dashboards/covid19/cases [Last accessed on 2024 Mar 17].

[3] Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020;395:1054-1062. doi: 10.1016/S0140-6736(20)30566-3

[4] Harapan H, Itoh N, Yufika A, et al. Coronavirus disease 2019 (COVID-19): A literature review. J Infect Public Health. 2020; 13:667-673. doi: 10.1016/J.JIPH.2020.03.019

[5] Sheahan TP, Sims AC, Graham RL, et al. Broad-spectrum antiviral GS-5734 inhibits both epidemic and zoonotic coronaviruses. Sci Transl Med. 2017; 9(396):eaal3653. doi: 10.1126/scitranslmed.aal3653

[6] FDA. Coronavirus (COVID-19) Update: FDA Issues Emergency Use Authorization for Potential COVID-19 Treatment. U.S. Food Drug Administration; 2020. Available form: https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda/issues/emergency/use/authorization/potential/covid/19/treatment#:-:text=today%2c/the/u.s/food/and/children/hospitalized/with/severe/disease [Last accessed on 2024 Mar 17].

[7] FDA. Approves First Treatment for COVID-19. FDA. Available from: https://www.fda.gov/news/events/press/announcements/fda/approves/first/treatment/covid-19 [Last accessed on 2024 Mar 17].

[8] Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the treatment of Covid-19 - final report. N Engl J Med. 2020;383:1813-1826. doi: 10.1056/NEJMOA2007764

[9] Kaka AS, MacDonald R, Linskens EJ, et al. Major update 2: Remdesivir for adults with COVID-19: A living systematic review and meta-analysis for the American college of physicians practice points. Ann Intern Med. 2022;175:701-709. doi: 10.7326/M21-4784

[10] WHO Solidarity Trial Consortium. Remdesivir and three other drugs for hospitalised patients with COVID-19: Final results of the WHO Solidarity randomised trial and updated meta-analyses. Lancet. 2022;399:1941-1953. doi: 10.1016/S0140-6736(22)00519-0

[11] Mozaffari E, Chandak A, Zhang Z, et al. Remdesivir treatment in hospitalized patients with coronavirus disease 2019 (COVID-19): A comparative analysis of in-hospital all-cause mortality in a large multicenter observational cohort. Clin Infect Dis. 2022;75:e450-e458. doi: 10.1093/CID/CIAB875

[12] Spinner CD, Gottlieb RL, Criner GJ, et al. Effect of remdesivir vs standard care on clinical status at 11 days in patients with moderate COVID-19: A randomized clinical trial. JAMA. 2020; 324:1048-1057. doi: 10.1001/JAMA.2020.16349

[13] Ali K, Azher T, Baqi M, et al. Remdesivir for the treatment of patients in hospital with COVID-19 in Canada: A randomized controlled trial. CMAJ. 2022;194:E242-E251. doi: 10.1503/CMAJ.211698

[14] Gottlieb RL, Vaca CE, Paredes R, et al. Early remdesivir to prevent progression to severe Covid-19 in outpatients. N Engl J Med. 2022;386:305-315. doi: 10.1056/NEJMOA2116846

[15] Boglione L, Dodaro V, Meli G, et al. Remdesivir treatment in hospitalized patients affected by COVID‐19 pneumonia: A case‐control study. J Med Virol. 2022; 94:3653-3660. doi: 10.1002/JMV.27768

[16] Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020;395:507-513. doi: 10.1016/S0140-6736(20)30211-7

[17] Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. Lancet Respir Med. 2020;8:475-481. doi: 10.1016/S2213-2600(20)30079-5

[18] Antinori S, Cossu MV, Ridolfo AL, et al. Compassionate remdesivir treatment of severe Covid-19 pneumonia in intensive care unit (ICU) and Non-ICU patients: Clinical outcome and differences in post-treatment hospitalisation status. Pharmacol Res. 2020;158:104899. doi: 10.1016/J.PHRS.2020.104899

[19] Hasanoğlu I, Güner R, Çelik I, et al.Remdesivir treatment for patients with moderate to severe COVID-19. Turk J Med Sci. 2022;52:880-887. doi: 10.55730/1300-0144.5387

[20] Tsuzuki S, Hayakawa K, Uemura Y, et al. Effectiveness of remdesivir in hospitalized nonsevere patients with COVID-19 in Japan: A large observational study using the COVID-19 registry Japan. Int J Infect Dis. 2022; 118:119-125. doi: 10.1016/J.IJID.2022.02.039

[21] Davies NG, Klepac P, Liu Y, et al. Age-dependent effects in the transmission and control of COVID-19 epidemics. Nat Med. 2020;26:1205-1211. doi: 10.1038/S41591-020-0962-9

[22] Amgalan A, Malinowski AK, Othman M. COVID-19 and sex-/gender-specific differences: Understanding the discrimination. Semin Thromb Hemost. 2021;47:341-347. doi: 10.1055/S-0040-1715455

[23] Acharya TA, Joshi KJ, Patel DD, Shah SN, Mehta DS. Study of clinical outcome and healthcare modalities of COVID-19 patients treated with remdesivir at a tertiary care teaching hospital. Cureus. 2022; 14(1):e21535. doi: 10.7759/CUREUS.21535

[24] Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 Patients hospitalized with COVID-19 in the New York City Area. JAMA. 2020; 323:2052-2059. doi: 10.1001/jama.2020.6775

[25] Goldman JD, Lye DCB, Hui DS, et al.Remdesivir for 5 or 10 days in patients with severe Covid-19. N Engl J Med. 2020;383:1827-1837. doi: 10.1056/NEJMOA2015301

[26] Pasquini Z, Montalti R, Temperoni C, et al. Effectiveness of remdesivir in patients with COVID-19 under mechanical ventilation in an Italian ICU. J Antimicrob Chemother. 2020;75:3359-3365. doi: 10.1093/JAC/DKAA321

[27] Manudhane G, Kumbhar M, Yadav A, et al. To study role of remdesivir in COVID 19 patients at a tertiary referral hospital in Mumbai, India. J Assoc Physicians India. 2021;69:30-32.

[28] Gao YD, Ding M, Dong X, et al. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy. 2021; 76:428-455. doi: 10.1111/ALL.14657

[29] Ayodele O, Ren K, Zhao J, et al. Real-world treatment patterns and clinical outcomes for inpatients with COVID-19 in the US from September 2020 to February 2021. PLoS One. 2021; 16(12):e0261707. doi: 10.1371/JOURNAL.PONE.0261707

[30] Vititoe SE, Govil P, Baglivo A, et al. A descriptive cohort study of drug utilization patterns among patients hospitalized with coronavirus disease 2019 in the United States, January 2021-February 2022. Open Forum Infect Dis. 2023; 10(7):ofad339. doi: 10.1093/OFID/OFAD339

[31] Kalil AC, Patterson TF, Mehta AK, et al.Baricitinib plus remdesivir for hospitalized adults with Covid-19. N Engl J Med. 2021;384:795-807. doi: 10.1056/NEJMOA2031994

[32] Karolyi M, Kaltenegger L, Pawelka E, et al. Early administration of remdesivir may reduce mortality in hospitalized COVID-19 patients : A propensity score matched analysis. Wien Klin Wochenschr. 2022;134: 883-891. doi: 10.1007/S00508-022-02098-9

[33] Tejada D, Juanbeltz R, Rivero M, et al. Clinical course of patients with severe COVID-19 pneumonia treated with remdesivir: A real-life study. PLoS One. 2022; 17(4):e0267283. doi: 10.1371/JOURNAL.PONE.0267283

[34] Sellers J, Chang J, Jones J, Hintze TD. Patients with moderate to severe COVID-19 outcomes on remdesivir according to baseline 4C mortality score. Pulm Pharmacol Ther. 2023;78:102188. doi: 10.1016/J.PUPT.2022.102188