(140) Systemic Steroids and its Combination with Remdesivir in Hospitalized COVID-19 Patients: A Retrospective Cohort Study

Publication Number: 476

Background: Several drugs were investigated for their potential role in mitigating COVID-19-related morbidity and mortality; Among them, mainly steroids and remdesivir gained global prominence. Nonetheless, there is limited evidence that combining these two drugs may improve patient prognosis.

Objectives: To evaluate the clinical impact of systemic steroids administered with or without remdesivir in hospitalized COVID-19, including in-hospital mortality.

Methods: This retrospective cohort study included 544 COVID–19–diagnosed patients treated with steroids (methylprednisolone, dexamethasone, and hydrocortisone), admitted between 1st December 2020 to 1st September 2021 in a tertiary-healthcare facility in South India. These patients were divided into two groups: study cohorts (SC=396), those who received remdesivir and reference cohort (RC=148), those without remdesivir. The odds ratio (OR) was calculated for the risk estimation, and major clinical outcomes were analyzed using chi-square and unpaired t-test or Mann-Whitney U test.

Results: The odds of invasive mechanical ventilation (IMV) [OR: 2.18; 95% CI, 1.46 – 3.25, p < 0.001] and mortality (OR: 1.77; 95% CI, 1.17 – 2.69, p < 0.01) were significantly higher in the SC than RC. Furthermore, time to clinical improvement [12 days ( IQR, 9 – 18) vs 7 days ( IQR, 5 –9) p < 0.001] and time to death [ 13 days ( IQR, 7 – 18) vs 7 days ( IQR, 5 – 9) p < 0.001] was significantly longer in the SC than the RC. In patients who had IMV, the odds of mortality were lower in the SC than in the RC (OR: 0.53; 95% CI, 0.20 – 1.42), however, statistically not significant. The risk of progression to IMV in severe patients was lower for SC than RC ( OR: 0.47; 95% CI, 0.24 – 0.91, p < 0.05). Sub-group analysis revealed factors that contributed to an increased likelihood of mortality in COVID-19 patients: age≥ 50 years, number of comorbidities, IHD, and kidney disease.

Conclusions: The study reveals that severe COVID-19 patients treated with a combination therapy of systemic steroids and remdesivir had a reduced risk of requiring IMV than patients treated with systemic steroids only. Similarly, a reduction in mortality risk was observed in patients under IMV treated with systemic steroids and remdesivir. Therefore, the study suggests that combination therapy of systemic steroids and remdesivir is partially justified as the treatment regimen for severe COVID-19. However, further studies are warranted to establish mortality benefits.