Examining Remdesivir in Elderly Patients Hospitalized for COVID-19 | ASHP Midyear

Remdesivir led to significant reductions in mortality among elderly patients hospitalized with COVID-19 during the time when the Omicron variant was predominant, according to research presented at the American Society of Health-System Pharmacists 2024 Midyear Clinical Meeting and Exhibition, held December 8 to 12 in New Orleans, Louisiana.¹

Examining Remdesivir in Elderly Patients Hospitalized for COVID-19 | ASHP Midyear / Bernard Chantal - stock.adobe.com

Remdesivir is a direct-acting nucleotide prodrug inhibitor of the SARS-CoV-2 RNA-dependent RNA polymerase.² The antiviral therapy has potent nanomolar activity in primary human airway epithelial cells and was identified early in the pandemic as a promising therapeutic agent to potentially treat COVID-19.

READ MORE: Phase 3 Trial to Evaluate Molnupiravir for Treatment of COVID-19 in High-Risk Adults

“Previous research has established the effectiveness of remdesivir in reducing mortality among vulnerable patient populations such as immunocompromised and cancer patients hospitalized for COVID-19,” the authors wrote. “However, evidence on the elderly population is sparse.”

A team of investigators from Gilead Sciences, Certara, and Brigham and Women’s Hospital conducted a study to examine in-hospital all-cause mortality for early remdesivir initiation compared to not initiating the therapy among elderly patients hospitalized for COVID-19 during the Omicron predominant period. Data for the study was gathered from the PINC AI Healthcare database.

The study cohort included 110044 patients aged 65 or older who were hospitalized and had a primary discharge diagnosis of COVID-19 between December 2021 and April 2023. Patients who initiated remdesivir in the first 2 days of admission were compared to patients who did not start the therapy. Data analyses were stratified by age, no supplemental oxygen charges, low-flow oxygen, and high-flow oxygen/non-invasive ventilation or invasive mechanical ventilation upon hospital admission.

There were 45038 patients who initiated remdesivir and these were matched with 20425 patients who did not initiate the therapy. Of those, 64% were 75 years of age or older, 46% had no supplemental oxygen charges, and 54% had some form of supplemental oxygen charges.

The study found that unadjusted mortality rates for patients who received remdesivir were 9.9% at day 14 and 13.3% at day 28. This is compared to 13% at day 14 and 16.9% at day 28 for patients who did not receive remdesivir. In the overall study cohort, remdesivir was associated with a significantly lower 14- and 28-day mortality rate. Additionally, the effectiveness of remdesivir was consistent among patients who received any form of supplemental oxygen and across all age groups.

“In the Omicron predominant COVID-19 era, initiation of remdesivir in elderly patients hospitalized for COVID-19 demonstrated significant mortality reduction, which was consistent across baseline supplemental oxygen requirements and age groups,” the authors concluded.

READ MORE: COVID-19 Resource Center

Follow along with our coverage of the 2024 ASHP Midyear Clinical Meeting and Exhibition here.

References

1. Mozaffari E, Chandak A, Sax PE, et al. Remdesivir Reduces Mortality in Elderly Patients 65+ Years Hospitalized for COVID-19 During Omicron. Presented at: American Society of Health-System Pharmacists 2024 Midyear Clinical Meeting and Exhibition; December 8-12, 2024; New Orleans, LA. Poster 8-053.

2. Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. 2020 Nov 5;383(19):1813-1826. doi: 10.1056/NEJMoa2007764. Epub 2020 Oct 8. PMID: 32445440; PMCID: PMC7262788.