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Inicio Medicina Clínica (English Edition) Remdesivir plus dexamethasone is associated to improve in the clinical outcome o...
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Vol. 161. Issue 4.
Pages 139-146 (August 2023)
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Vol. 161. Issue 4.
Pages 139-146 (August 2023)
Original article
Remdesivir plus dexamethasone is associated to improve in the clinical outcome of COVID-19 hospitalized patients regardless of their vaccination status
Remdesivir más dexametasona se asocian a una reducción de los eventos clínicos en los pacientes hospitalizados por COVID-19, independientemente de su estado de vacunación
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Enrique Bernala,
Corresponding author
ebm.hgurs@gmail.com

Corresponding author.
, Eva García-Villalbab, Eduardo Ponsa, Maria Dolores Hernándeza, Carlos Báguenaa, Gabriel Puchea, Paula Cartera, Mónica Martineza, Antonia Alcaraza, Cristina Tomása, Angeles Muñoza, Maria Rosario Vicentec, Maria Luz Nuñezc, Natalia Sanchoe, Mari Carmen Villalbaa, Alfredo Canoa, Alfredo Minguelad
a Infectious Disease Unit, Reina Sofia University Hospital and Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
b Internal Medicine Service, Los Arcos del Mar Menor Hospital and Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
c Microbiology Service, Reina Sofia University Hospital and Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
d Immunology Service, Virgen de la Arrrixaca University Clinical Hospital (HCUVA), Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
e Laboratory Medicine Department, Reina Sofia University Hospital and Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
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Tables (3)
Table 1. Patients’ characteristics and clinical evolution according to treatment received.
Table 2. Characteristics of patients according to their outcome.
Table 3. Cox regression of factors associated with ventilation or death.
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Abstract
Introduction

Remdesivir seems to reduce the risk of hospitalization and improve clinical outcome in hospitalized patients with COVID-19.

Objectives

To compare the clinical outcome of COVID-19 hospitalized patients treated with remdesivir plus dexamethasone versus dexamethasone alone, according to their vaccination status.

Material and methods

A retrospective observational study was carried out in 165 patients hospitalized for COVID-19 from October 2021 to January 2022. Multivariate logistic regression, Kaplan–Meier and the log-rank tests were used to evaluate the event (need for ventilation or death).

Results

Patients treated with remdesivir plus dexamethasone (n=87) compared with dexamethasone alone (n=78) showed similar age (60±16, 47–70 vs. 62±37, 51–74 years) and number of comorbidities: 1 (0–2) versus 1.5 (1–3). Among 73 fully vaccinated patients, 42 (47.1%) were in remdesivir plus dexamethasone and 31 (41%) in dexamethasone alone. Patients treated with remdesivir plus dexamethasone needed intensive care less frequently (17.2% vs. 31%; p=0.002), high-flow oxygen (25.3% vs. 50.0%; p=0.002) and non-invasive mechanical ventilation (16.1% vs. 47.4%; p<0.001). Furthermore, they had less complications during hospitalization (31.0% vs. 52.6%; p=0.008), need of antibiotics (32.2% vs. 59%; p=0.001) and radiologic worsening (21.8% vs. 44.9%; p=0.005). Treatment with remdesivir plus dexamethasone (aHR, 0.26; 95% CI: 0.14–0.48; p<0.001) and vaccination (aHR 0.39; 95% CI: 0.21–0.74) were independent factors associated with lower progression to mechanical ventilation or death.

Conclusions

Remdesivir in combination with dexamethasone and vaccination independently and synergistically protects hospitalized COVID-19 patients requiring oxygen therapy from progression to severe disease or dead.

Keywords:
Vaccination
Remdesivir
COVID-19
Hospitalization
Dexamethasone
Resumen
Introducción

Remdesivir parece reducir el riesgo de hospitalización y mejorar el resultado clínico en pacientes hospitalizados con COVID-19.

Objetivos

Comparar el desenlace clínico de pacientes hospitalizados con COVID-19 tratados con remdesivir más dexametasona vs. dexametasona sola, según su estado de vacunación.

Material y métodos

Se realizó un estudio observacional retrospectivo en 165 pacientes hospitalizados por COVID-19 desde octubre de 2021 hasta enero de 2022. Se consideró como evento la necesidad de ventilación o muerte.

Resultados

Los pacientes tratados con remdesivir más dexametasona (n=87) en comparación con dexametasona sola (n=78) mostraron una edad similar (60±16, 47-70 vs. 62±37, 51-74 años) y número de comorbilidades: 1 (0-2) vs. 1,5 (1-3). Entre 73 pacientes completamente vacunados, 42 (47,1%) estaban en remdesivir más dexametasona y 31 (41%) en dexametasona sola. Los pacientes tratados con remdesivir más dexametasona necesitaron cuidados intensivos con menos frecuencia (17,2 vs. 31%; p=0,002), oxígeno de alto flujo (25,3 vs. 50%; p=0,002) y ventilación mecánica no invasiva (16,1 vs. 47,4%, p<0,001). Además, tuvieron menos complicaciones durante la hospitalización (31 vs. 52,6%; p=0,008), necesidad de antibióticos (32,2 vs. 59%; p=0,001) y empeoramiento radiológico (21,8 vs. 44,9%; p=0,005). El tratamiento con remdesivir más dexametasona (aHR, 0,26; IC 95% 0,14-0,48; p<0,001) y la vacunación (aHR 0,39; IC 95% 0,21-0,74>) fueron factores independientes asociados con una menor progresión a ventilación mecánica o muerte.

Conclusiones

Remdesivir en combinación con dexametasona protegieron de forma independiente y sinérgica a los pacientes hospitalizados con COVID-19 que requieren oxigenoterapia de la progresión a la enfermedad grave o la muerte.

Palabras clave:
Vacunación
Remdesivir
COVID-19
Hospitalización
Dexametasona

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