(100) Timing and Duration of Remdesivir Treatment Among Individuals Hospitalized due to COVID-19 in the Capital Region of Denmark

Publication Number: 437

Background: Remdesivir has been approved in many countries for the treatment of hospitalized patients with COVID-19. Remdesivir use in Denmark for the treatment of COVID-19 among hospitalized patients were authorized by the European Medicines Agency in June 2020. Guidelines in Denmark recommend remdesivir use among individuals hospitalized with COVID-19 early (within 5 days of symptom onset) and for a duration of at least 5 days. The duration and timing of remdesivir treatment have not previously been described for COVID-19 patients in Denmark.

Objectives: We aimed to evaluate when remdesivir was initiated relative to the time of COVID-19 diagnosis in the hospital and the duration of the remdesivir treatment course.

Methods: We used electronic health records to obtain information on hospitalizations in the Capital Region of Denmark. We included individuals aged >=12 years with a primary diagnosis of COVID-19 between June, 4 2020 and November 28, 2021 (only the first COVID-19 hospitalization for each individual). We excluded individuals in a remdesivir trial, hospitalized for less than four hours or starting remdesivir before COVID-19 diagnosis. Remdesivir treatment was regarded as stopped or paused when there was a day without remdesivir treatment after the initiation of a remdesivir treatment course. Cumulative incidences of remdesivir initiation and discontinuation and 95% confidence intervals (95% CI) were estimated with the Aalen Johansen estimator accounting for death as a competing event.

Results: Among 5,639 individuals hospitalized with COVID-19 in the Capital Region of Denmark, 37% (95% CI: 36-38%) received remdesivir at some point during hospitalization: 32% (95% CI: 31-33%) received remdesivir within 2 days, 34% (95% CI: 33-36%) within 5 days and 37% (95% CI: 35-38%) within 10 days after the COVID-19 diagnosis. Death without prior remdesivir treatment occurred in 9% of the individuals. Among individuals who initiated remdesivir treatment, 11% (95% CI: 10-13%) stopped or paused remdesivir treatment within 2 days, 36% (95% CI: 34-37%) within 4 days and 84% (95% CI: 82-85%) within 5 days after initiation of remdesivir. Within 24 hours of remdesivir treatment stop, 3 % died and 31 % were discharged. Among those (3%) who re-started remdesivir treatment, 36% (95% CI: 25-47%) stopped remdesivir treatment within 2 days, 64% (95% CI: 52-74%) within 4 days and 85% (95% CI: 74-91%) within 5 days after initiation of the second remdesivir treatment course.

Conclusions: In the Capital Region of Denmark, most patients who received remdesivir started soon after COVID-19 diagnosis. The duration of remdesivir treatment was 5 days in approximately half of those receiving remdesivir.