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Evaluation of the effectiveness of remdesivir in treating severe COVID-19 using data from the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, national cohort study.

Arch, B. N.; Kovacs, D.; Scott, J. T.; Jones, A. P.; Harrison, E. M.; Rosala-Hallas, A.; Gamble, C. G.; Openshaw, P. J.; Baillie, J. K.; Semple, M. G.

2021-06-21 infectious diseases
10.1101/2021.06.18.21259072 medRxiv
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BackgroundRemdesivir has been evaluated in clinical trial populations, but there is a sparsity of evidence evaluating effectiveness in general populations. MethodsAdults eligible to be treated with remdesivir, requiring oxygen but not ventilated, were identified from UK patients hospitalised with COVID-19. Patients treated with remdesivir within 24h of hospitalisation were compared with propensity-score matched controls; estimates of effectiveness were calculated for short-term outcomes (14-day mortality, 28-day mortality, time-to-recovery among others) using multivariable modelling. Results9,278 out of 39,330 patients satisfied eligibility criteria. 1,549 patients were identified as treated and matched with 4,964 controls. Patients were 62% male, mean (SD) age 63.1 (15.6) years, 80% White ethnicity, and symptomatic for a median of 6 days prior to baseline. There was no statistically significant benefit of remdesivir at 14 days in terms of mortality or clinical status; there were signals of effectiveness in time-to-recovery after day 9, and a reduction in 28-day mortality. ConclusionIn a real-world setting, initiation of remdesivir within 24h of hospitalisation in conjunction with standard of care was not associated with a benefit at 14 days but supports clinical trial evidence of a potential reduction in 28-day mortality.

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