Lower Mortality Risk Associated With Remdesivir plus Dexamethasone Versus Dexamethasone Alone for the Treatment of Patients Hospitalized for COVID-19

Background. Treatment guidelines were developed early in the pandemic when much about coronavirus disease 2019 (COVID-19) was unknown. Given the evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), real-world data can provide clinicians with updated information. The objective of this analysis was to assess mortality risk in patients hospitalized for COVID-19 during the Omicron period receiving remdesivir + dexamethasone versus dexamethasone alone. Methods. A large, multicenter US hospital database was used to identify adult patients hospitalized with a primary discharge diagnosis of COVID-19 flagged as "present-on-admission" and treated with remdesivir + dexamethasone or dexamethasone alone between December 2021 and April 2023. Patients were matched using 1:1 propensity score matching and stratified by baseline oxygen requirements. Cox proportional hazards model was used to assess time to 14- and 28-day in-hospital all-cause mortality. Results. A total of 33 037 patients were matched, with most patients >= 65 years old (72%), White (78%), and non-Hispanic (84%). Remdesivir + dexamethasone was associated with lower mortality risk versus dexamethasone alone across all baseline oxygen requirements at 14-days (no supplemental oxygen charges: adjusted hazard ratio [95% confidence interval {CI}]: 0.79 [.72-.87], low flow oxygen: 0.70 [.64-.77], high flow oxygen/non-invasive ventilation: 0.69 [.62-.76], invasive mechanical ventilation/extracorporeal membrane oxygen (IMV/ECMO): 0.78 [.64-.94]), with similar results at 28-days. Conclusions. Remdesivir + dexamethasone was associated with a significant reduction in 14- and 28-day mortality compared to dexamethasone alone in patients hospitalized for COVID-19 across all levels of baseline respiratory support, including IMV/ECMO. However, the use of remdesivir + dexamethasone still has low clinical practice uptake. In addition, these data suggest a need to update the existing guidelines.