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Research shows remdesivir treatment for COVID-19 has little impact on survival, increases hospital stay

Date: Monday, July 19, 2021
Michael Ohl, portrait
Michael Ohl, MD, MSPH

A new study finds that remdesivir, the first new medicine approved for treatment of COVID-19, is not associated with improved survival, but is associated with longer hospital stays for patients.

The research, led by Michael Ohl, MD, MSPH, associate professor of internal medicine in the University of Iowa Carver College of Medicine, raises concerns that remdesivir treatment may have increased utilization of hospital beds when they were scarce during the COVID-19 pandemic—without clear improvements in survival.

“Examination of time to remdesivir completion and discharge suggests that clinicians may have been keeping people in hospital to complete five- and 10-day remdesivir courses, contributing to longer length of stay,” Ohl says.

The results of the study contradict previous clinical trials of remdesivir, which suggested the treatment would shorten time to clinical recovery for people hospitalized with the virus, allowing for faster discharge of patients from hospitals and more open beds to treat people during the pandemic.

However, there was little information during initial clinical trials about the impact of remdesivir treatment on survival and length of hospital stay for COVID-19 in a “real-world” care setting, says Ohl, who also is a physician with the Iowa City Veterans Affairs (VA) Health Care System, Iowa City. His research used recent national data from the Veteran Health Administration to examine these factors among veterans with COVID-19.

The observational study tracked outcomes for 2,344 hospitalized adults with COVID-19 in 123 VA hospitals—1172 remdesivir recipients and 1172 matched controls who did not receive remdesivir.  The analysis showed that remdesivir therapy was not associated with improved 30-day survival, but was associated with a 3-day increase in median time to hospital discharge—a significant difference.

Ohl’s findings were recently published in a paper in Jama Network Open, titled “Association of Remdesivir Treatment with Survival and Length of Hospital Stay Among US Veterans Hospitalized with COVID-19.”

Remdesivir is still widely used for COVID-19 at hospitals nationwide, including at UI Hospitals and Clinics. However, Ohl notes that since the initial approval of remdesivir in 2020, UI Health Care physicians have been very careful to assure that patients with COVID-19 are not kept in the hospital solely to complete treatment if they are otherwise stable for discharge.

“So, the length of stay issue we saw in the paper is probably not significant at UI Hospitals and Clinics,” Ohl says. “That said, I think the practice of keeping patients in hospital to complete remdesivir courses may still be an issue at other hospitals around the country.”

The study had some limitations, including the fact that the 1172 remdesivir recipients included in the study were the patients who could be matched to controls who did not receive remdesivir. These 1172 patients represented only about half of the total 2374 VA patients who received remdesivir, and they had a lower propensity for remdesivir treatment and less severe illness compared with remdesivir recipients who were not able to be matched to control patients. The  researchers note this means the results may not be generalizable to all patients who receive remdesivir.

This study was supported by a grant from the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service. In addition to researchers with UI Health Care and the Iowa City Veterans Affairs Health Care System, the team also included researchers at the University of Massachusetts Lowell and the University of Washington in Seattle.

In addition to Ohl, the research team included Donald Miller; Brian Lund; Takaaki Kobayashi; Kelly Richardson Miell; Brice Beck; Bruce Alexander; Kristina Crother; and Mary S. Vaughan Sarrazin.