Skip NavigationSkip to Content
Return Return to Search Results

Deconstructing the Treatment Effect of Remdesivir in the Adaptive COVID-19 Treatment Trial-1: Implications for Critical Care Resource Utilization

  1. Author:
    Fintzi, Jonathan [ORCID]
    Bonnett,Tyler
    Sweeney, Daniel A
    Huprikar, Nikhil A
    Ganesan, Anuradha
    Frank, Maria G
    McLellan, Susan L F
    Dodd, Lori E
    Tebas, Pablo
    Mehta, Aneesh K

  2. Author Address

    Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA., Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA., Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, La Jolla, CA, USA., Pulmonary and Critical Care Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA., Walter Reed National Military Medical Center, Infectious Disease Clinical Research Program, Department of Preventative Medicine and Biostatistics, Uniformed Services University of Health Sciences, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA., Department of Medicine, Denver Health Hospital Authority, of Medicine, University of Colorado School of Medicine, Aurora, CO, USA., Division of Infectious Disease, University of Texas Medical Branch, Galveston, TX, USA., Division of Infectious Diseases/Clinical Trials Unit, University of Pennsylvania, Philadelphia, PA, USA., Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,
    1. Year: 2021
    2. Date: Aug 19
    3. Epub Date: 2021 08 19
  2. Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  4. Type of Article: Article
  5. Article Number: ciab712
  1. Abstract:

    The Adaptive COVID-19 Treatment Trial-1 (ACTT-1) found that remdesivir therapy hastened recovery in patients hospitalized with COVID-19, but the pathway for this improvement was not explored. We investigated how the dynamics of clinical progression changed along 4 pathways: recovery, improvement in respiratory therapy requirement, deterioration in respiratory therapy requirement, and death. We analyzed trajectories of daily ordinal severity scores reflecting oxygen requirements of 1051 patients hospitalized with COVID-19 who participated in ACTT-1. We developed competing risks models that estimate the effect of remdesivir therapy on cumulative incidence of clinical improvement and deterioration, and multistate models that utilize the entirety of each patient's clinical course to characterize the effect of remdesivir on progression along the 4 pathways above. Based on a competing risks analysis, remdesivir reduced clinical deterioration (hazard ratio, 0.73; 95% CI, 0.59-0.91) and increased clinical improvement (hazard ratio, 1.22; 95% CI, 1.08, 1.39) relative to baseline. Our multistate models indicate that remdesivir inhibits worsening to ordinal scores of greater clinical severity among patients on room air or low-flow oxygen (hazard ratio, 0.74; 95% CI, 0.57-0.94) and among patients receiving mechanical ventilation or high-flow oxygen/noninvasive positive-pressure ventilation (hazard ratio, 0.73; 95% CI, 0.53-1.00) at baseline. We also find that remdesivir reduces expected intensive care respiratory therapy utilization among patients not mechanically ventilated at baseline. Remdesivir speeds time to recovery by preventing worsening to clinical states that would extend the course of hospitalization and increase intensive respiratory support, thereby reducing the overall demand for hospital care. Published by Oxford University Press for the Infectious Diseases Society of America 2021.

    See More

  1. Keywords:

External Sources

  1. View Full Text
  2. DOI: 10.1093/cid/ciab712
  3. PMID: 34409989
  4. PII : 6354746

Library Notes

  1. Fiscal Year: FY2020-2021
NCI at Frederick

You are leaving a government website.

This external link provides additional information that is consistent with the intended purpose of this site. The government cannot attest to the accuracy of a non-federal site.

Linking to a non-federal site does not constitute an endorsement by this institution or any of its employees of the sponsors or the information and products presented on the site. You will be subject to the destination site's privacy policy when you follow the link.

ContinueCancel