Drug Duo Improves COVID-19 Outcomes: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On October 10, 2024, we reported on a study published in the journal Clinical Infectious Diseases that examined the mortality risk in adults hospitalized for COVID-19 during the Omicron period receiving remdesivir plus dexamethasone versus dexamethasone alone.

The study

Researchers analyzed data from the PINC AI Healthcare Database, which represents approximately 25% of yearly inpatient hospitalizations in the US. They identified adults hospitalized with COVID-19 who received either remdesivir plus dexamethasone or dexamethasone alone between December 2021 and April 2023.

Using propensity score matching, 33 037 individuals who received remdesivir plus dexamethasone were matched in a 1:1 ratio to those who received dexamethasone monotherapy and stratified by baseline oxygen requirements. Cox proportional hazards model was used to analyze time to 14- and 28-day in-hospital all-cause mortality.

The findings

At 14 days, remdesivir plus dexamethasone was associated with lower mortality risk vs dexamethasone alone across all baseline oxygen requirements:

• No supplemental oxygen: adjusted hazard ratio (aHR) 0.79 (95% CI 0.72-0.87).

• Low flow oxygen: aHR 0.70 (95% CI 0.64-0.77).

• High flow oxygen/non-invasive ventilation: aHR 0.69 (95% CI 0.62-0.76).

• Invasive mechanical ventilation/extracorporeal membrane oxygen (IMV/ECMO): aHR 0.78 (95% CI 0.64-0.94).

Investigators reported similar results at 28 days.

Authors' comment

"Findings from this research suggest that more effort is needed to update guidelines recommending the use of remdesivir + dexamethasone in patients requiring supplemental oxygen according to best practice guidelines for oxygen use, and the strong clinical rationale to avoid dexamethasone monotherapy in all levels of respiratory support, especially those not receiving supplemental oxygen."

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