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Effectiveness of remdesivir in patients with COVID-19 under mechanical ventilation in an Italian ICU

Pasquini et al., Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkaa321
Aug 2020  
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Mortality 16% Improvement Relative Risk HCQ for COVID-19  Pasquini et al.  ICU PATIENTS Is very late treatment with HCQ beneficial for COVID-19? Retrospective 51 patients in Italy Lower mortality with HCQ (not stat. sig., p=0.34) c19hcq.org Pasquini et al., J. Antimicrobial Chem.., Aug 2020 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020, now with p < 0.00000000001 from 418 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments.
5,000+ studies for 104 treatments. c19hcq.org
Retrospective 51 ICU patients under mechanical ventilation, 33 treated with HCQ, showing unadjusted lower mortality with treatment.
Although the 16% lower mortality is not statistically significant, it is consistent with the significant 26% lower mortality [22‑30%] from meta analysis of the 252 mortality results to date.
This study is excluded in the after exclusion results of meta analysis: unadjusted results with no group details.
Study covers HCQ and remdesivir.
risk of death, 16.4% lower, RR 0.84, p = 0.34, treatment 23 of 33 (69.7%), control 15 of 18 (83.3%), NNT 7.3.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Pasquini et al., 23 Aug 2020, retrospective, Italy, peer-reviewed, 9 authors, average treatment delay 10.0 days.
This PaperHCQAll
Effectiveness of remdesivir in patients with COVID-19 under mechanical ventilation in an Italian ICU
Zeno Pasquini, Roberto Montalti, Chiara Temperoni, Benedetta Canovari, Mauro Mancini, Michele Tempesta, Daniela Pimpini, Nicoletta Zallocco, Francesco Barchiesi
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkaa321
Background: Remdesivir is a prodrug with in vitro activity against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Its clinical efficacy in patients with COVID-19 under mechanical ventilation remains to be evaluated. Methods: This study includes patients under mechanical ventilation with confirmed SARS-CoV-2 infection admitted to the ICU of Pesaro hospital between 29 February and 20 March 2020. During this period, remdesivir was provided on a compassionate use basis. Clinical characteristics and outcome of patients treated with remdesivir were collected retrospectively and compared with those of patients hospitalized in the same time period. Results: A total of 51 patients were considered, of which 25 were treated with remdesivir. The median (IQR) age was 67 (59-75.5) years, 92% were men and symptom onset was 10 (8-12) days before admission to ICU. At baseline, there was no significant difference in demographic characteristics, comorbidities and laboratory values between patients treated and not treated with remdesivir. Median follow-up was 52 (46-57) days. Kaplan-Meier curves showed significantly lower mortality among patients who had been treated with remdesivir (56% versus 92%, P < 0.001). Cox regression analysis showed that the Charlson Comorbidity Index was the only factor that had a significant association with higher mortality (OR 1.184; 95% CI 1.027-1.365; P = 0.020), while the use of remdesivir was associated with better survival (OR 3.506; 95% CI 1.768-6.954; P < 0.001). Conclusions: In this study the mortality rate of patients with COVID-19 under mechanical ventilation is confirmed to be high. The use of remdesivir was associated with a significant beneficial effect on survival.
Transparency declarations None to declare.
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Late treatment
is less effective
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