Reduced risk of death in people with SARS-CoV-2 infection treated with remdesivir: a nested case-control study.

INTRODUCTION: Since the start of the SARS-CoV-2 pandemic, several treatment options have been proposed (e.g. steroids, heparin, antivirals, and monoclonal antibodies). Remdesivir was the first antiviral approved for the treatment of COVID-19, even though controversial evidence exists concerning the efficacy. Therefore, we aimed to conduct a study to evaluate if the use of remdesivir was associated with lower mortality in patients with COVID-19. METHODS: We conducted a nested case-controlled study of a retrospective cohort collecting medical records of people with SARS-CoV-2 infection admitted in the infectious Disease Unit of Sassari University Hospital (S.C. Clinica di Malattie Infettive, AOU di Sassari, Italy), or in the Infectious disease Unit of Foggia (A.O.U. "Ospedali Riuniti" Foggia), between 01/07/2020 and 10/11/2021. The outcome considered was death; thus, we matched death (cases) to survivors (controls) by sex and age (1:1). RESULTS: We included in the study 342 patients, with 171 deaths (cases) and 171 survivors (controls). Remdesivir was administered to 60 people in the controls group and to 18 people in the cases group (35.1% vs. 10.5%, p-value <0.0001). In the multivariate analysis, treatment with remdesivir and heparin was associated with a lower mortality (OR:0.19 [95%CI:0.10-0.38], p-value <0.0001; OR:0.39 [95%CI:0.21-0.74] p-value= 0.004, respectively). On the contrary, diabetes, oxygen therapy, and CPAP/NIV were associated with higher mortality. CONCLUSION: Our study showed a lower mortality in people with SARS-CoV-2 infection treated with remdesivir.