505 - Impact of remdesivir on SARS-CoV-2 Clearance in a Real-Life Setting: a Matched-Cohort Study

Background: Evidence regarding the impact of remdesivir (RDV) on SARS-CoV-2 viral clearance (VC) is scarce. Aim of this study was to compare VC timing in COVID-19 patients who received RDV with those who did not.

Methods:

Matched-cohort study conducted (25 February 2020-15 April 2021) at the IRCSS San Raffaele, Milan, Italy. The study enrolled hospitalized patients with pneumonia and a SARS-CoV-2 positive nasopharyngeal swab (NPS) at admission and at least one NPS during follow-up. Follow-up started at hospital admission and ended at the date of the first negative NPS (within 30 days after discharge). Patients who received RDV (cases) and patients who did not (controls) were matched based on age (±5 years), sex and PaO₂/FiO₂(P/F; ±10mmHg) values at admission.

NPS were analyzed with RT-PCR.
Results described as median (IQR) or frequency (%). Time to VC was estimated with Kaplan-Meier curve and compared with log-rank test.

Results:

648 patients were enrolled: 216 cases and 432 controls. Patients’ characteristics at admission are reported in Table 1. VC was observed in 490 patients (75.6%) in a median time of 25 (16-34) days. Overall, time to VC was similar in patients receiving or not receiving remdesivir (p=0.519). However, time to VC was different when considering both the use of RDV (yes vs no) and age (≤ or > 63 years), as shown in Figure 1A. A significant finding was also observed considering the use of RDV and P/F values at admission (≤ or > 200mmHg), as reported in Figure 1B.

Among the 490 patients who reached VC during follow-up, overall time to VC was similar in patients receiving or not receiving RDV (p=0.075; Figure 2 Panel A); however, RDV use was associated with a higher probability of VC in the subgroup of patients with P/F admission values ≤ 200mmHg (p=0.035; Figure 2 Panel B), in the age group 55-65 years (p=0.025; Figure 2 Panel C) and in patients with comorbidities (p=0.028).Table 1
Characteristics, respiratory function and laboratory values at admission of hospitalized patients according to the use of remdesivir
Figure 1.
Figure 1A: Time to viral clearance according to the use of RDV (yes vs no) and age (≤ or > 63 years).
Figure 1B:Time to viral clearance according to the use of RDV and P/F at admission (≤ or > 200mmHg)
Figure 2.
Time to viral clearance among the 490 patients who reached VC during follow-up.
Panel A: time to VC according to RDV use.
Panel B: time to VC according to RDV and P/F ratio value at admission.
Panel C: time to VC according to RDV in the age group 55-65 years.

Conclusion:

Time to viral clearance was similar in patients receiving or not receiving remdesivir; however the use of RDV was associated with a benefit on time to viral clearance in younger patients and in those with a P/F ratio at admission ≤ 200mmHg.

Presenting Author(s)

Vincenzo Spagnuolo, MD

Assistant Professor
Vita-Salute San Raffaele University; Unit of Infectious Diseases, IRCCS, San Raffaele Scientific Institute
Milan, Emilia-Romagna, Italy
Disclosure: ViiV Healthcare (Other Financial or Material Support, Preparation of educational material)

Co-Author(s)

MV

Marta Voarino, n/a

Vita-Salute San Raffaele University
Milan, Lombardia, Italy
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MT

Marco Tonelli, MD

Vita Salute San Raffaele University; Unit of Microbiology and Virology, IRCCS San Raffaele Scientific Institute
Milan, Lombardia, Italy
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LG

Laura Galli, MSc

Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute
Milan, Lombardia, Italy
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AP

Andrea Poli, MSc

Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute
Milan, Lombardia, Italy
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
EB

Elena Bruzzesi, MD

Vita-Salute San Raffaele University; Unit of Infectious Diseases, IRCCS, San Raffaele Scientific Institute
Milan, Lombardia, Italy
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SR

Sara Racca, MD

Unit of Microbiology and Virology, IRCCS San Raffaele Scientific Institute
Milan, Lombardia, Italy
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
NC

Nicola Clementi, MD

Vita Salute San Raffaele University; Unit of Microbiology and Virology, IRCCS San Raffaele Scientific Institute
Milan, Lombardia, Italy
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CO

Chiara Oltolini, MD

Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute
Milan, Lombardia, Italy
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MT

Moreno Tresoldi, MD

General Medicine and Advanced Care Unit, IRCCS San Raffaele Scientific Institute
Milan, Lombardia, Italy
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
PR

Patrizia Rovere Querini, MD

Vita-Salute San Raffaele University; Internal Medicine, Diabetes, and Endocrinology Unit, IRCCS San Raffaele Scientific Institute
Milan, Lombardia, Italy
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LD

Lorenzo Dagna, MD

Vita-Salute San Raffaele University; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute
Milan, Lombardia, Italy
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AZ

Alberto Zangrillo, MD

Vita-Salute San Raffaele University; Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute
Milan, Lombardia, Italy
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
FC

Fabio Ciceri, MD

Vita-Salute San Raffaele University; Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute
Milan, Lombardia, Italy
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MC

Massimo Clementi, MD

Vita Salute San Raffaele University; Unit of Microbiology and Virology, IRCCS San Raffaele Scientific Institute
Milan, Lombardia, Italy
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AC

Antonella Castagna, MD

Investigator
IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University
Milano, Lombardia, Italy
Disclosure: Gilead Sciences (Other Financial or Material Support, Speaking fee)Jansenn-Cilag (Other Financial or Material Support, Speaking fee)MSD (Other Financial or Material Support, Speaking fee)Theratechnologies (Other Financial or Material Support, Speaking fee)ViiV Healthcare (Other Financial or Material Support, Speaking fee)