Treatment effect of remdesivir on the mortality of hospitalised COVID-19 patients in Switzerland across different patient groups: a tree-based model analysis
AIMS OF THE STUDY: Remdesivir has shown benefits against COVID-19. However, it remains unclear whether, to what extent, and among whom remdesivir can reduce COVID-19-related mortality. We explored whether the treatment response to remdesivir differed by patient characteristics. METHODS: We analys...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SMW supporting association (Trägerverein Swiss Medical Weekly SMW)
2023-08-01
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| Series: | Swiss Medical Weekly |
| Online Access: | https://smw.ch/index.php/smw/article/view/3444 |
| _version_ | 1797735626956603392 |
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| author | Janne Estill Plamenna Venkova-Marchevska Huldrych F. Günthard Sara Botero-Mesa Amaury Thiabaud Maroussia Roelens Laure Vancauwenberghe Lauro Damonti Ulrich Heininger Anne Iten Peter W. Schreiber Rami Sommerstein Sarah Tschudin-Sutter Nicolas Troillet Danielle Vuichard-Gysin Andreas Widmer Torsten Hothorn Olivia Keiser |
| author_facet | Janne Estill Plamenna Venkova-Marchevska Huldrych F. Günthard Sara Botero-Mesa Amaury Thiabaud Maroussia Roelens Laure Vancauwenberghe Lauro Damonti Ulrich Heininger Anne Iten Peter W. Schreiber Rami Sommerstein Sarah Tschudin-Sutter Nicolas Troillet Danielle Vuichard-Gysin Andreas Widmer Torsten Hothorn Olivia Keiser |
| author_sort | Janne Estill |
| collection | DOAJ |
| description |
AIMS OF THE STUDY: Remdesivir has shown benefits against COVID-19. However, it remains unclear whether, to what extent, and among whom remdesivir can reduce COVID-19-related mortality. We explored whether the treatment response to remdesivir differed by patient characteristics.
METHODS: We analysed data collected from a hospital surveillance study conducted in 21 referral hospitals in Switzerland between 2020 and 2022. We applied model-based recursive partitioning to group patients by the association between treatment levels and mortality. We included either treatment (levels: none, remdesivir within 7 days of symptom onset, remdesivir after 7 days, or another treatment), age and sex, or treatment only as regression variables. Candidate partitioning variables included a range of risk factors and comorbidities (and age and sex unless included in regression). We repeated the analyses using local centring to correct the results for the propensity to receive treatment.
RESULTS: Overall (n = 21,790 patients), remdesivir within 7 days was associated with increased mortality (adjusted hazard ratios 1.28–1.54 versus no treatment). The CURB-65 score caused the most instability in the regression parameters of the model. When adjusted for age and sex, patients receiving remdesivir within 7 days of onset had higher mortality than those not treated in all identified eight patient groups. When age and sex were included as partitioning variables instead, the number of groups increased to 19–20; in five to six of those branches, mortality was lower among patients who received early remdesivir. Factors determining the groups where remdesivir was potentially beneficial included the presence of oncological comorbidities, male sex, and high age.
CONCLUSIONS: Some subgroups of patients, such as individuals with oncological comorbidities or elderly males, may benefit from remdesivir.
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| first_indexed | 2024-03-12T13:01:46Z |
| format | Article |
| id | doaj.art-c0dbca8d9d664c8e9e11851e37429801 |
| institution | Directory Open Access Journal |
| issn | 1424-3997 |
| language | English |
| last_indexed | 2024-03-12T13:01:46Z |
| publishDate | 2023-08-01 |
| publisher | SMW supporting association (Trägerverein Swiss Medical Weekly SMW) |
| record_format | Article |
| series | Swiss Medical Weekly |
| spelling | doaj.art-c0dbca8d9d664c8e9e11851e374298012023-08-28T19:34:28ZengSMW supporting association (Trägerverein Swiss Medical Weekly SMW)Swiss Medical Weekly1424-39972023-08-01153810.57187/smw.2023.40095 Treatment effect of remdesivir on the mortality of hospitalised COVID-19 patients in Switzerland across different patient groups: a tree-based model analysisJanne EstillPlamenna Venkova-MarchevskaHuldrych F. GünthardSara Botero-MesaAmaury ThiabaudMaroussia RoelensLaure VancauwenbergheLauro DamontiUlrich HeiningerAnne ItenPeter W. SchreiberRami SommersteinSarah Tschudin-SutterNicolas TroilletDanielle Vuichard-GysinAndreas WidmerTorsten HothornOlivia Keiser AIMS OF THE STUDY: Remdesivir has shown benefits against COVID-19. However, it remains unclear whether, to what extent, and among whom remdesivir can reduce COVID-19-related mortality. We explored whether the treatment response to remdesivir differed by patient characteristics. METHODS: We analysed data collected from a hospital surveillance study conducted in 21 referral hospitals in Switzerland between 2020 and 2022. We applied model-based recursive partitioning to group patients by the association between treatment levels and mortality. We included either treatment (levels: none, remdesivir within 7 days of symptom onset, remdesivir after 7 days, or another treatment), age and sex, or treatment only as regression variables. Candidate partitioning variables included a range of risk factors and comorbidities (and age and sex unless included in regression). We repeated the analyses using local centring to correct the results for the propensity to receive treatment. RESULTS: Overall (n = 21,790 patients), remdesivir within 7 days was associated with increased mortality (adjusted hazard ratios 1.28–1.54 versus no treatment). The CURB-65 score caused the most instability in the regression parameters of the model. When adjusted for age and sex, patients receiving remdesivir within 7 days of onset had higher mortality than those not treated in all identified eight patient groups. When age and sex were included as partitioning variables instead, the number of groups increased to 19–20; in five to six of those branches, mortality was lower among patients who received early remdesivir. Factors determining the groups where remdesivir was potentially beneficial included the presence of oncological comorbidities, male sex, and high age. CONCLUSIONS: Some subgroups of patients, such as individuals with oncological comorbidities or elderly males, may benefit from remdesivir. https://smw.ch/index.php/smw/article/view/3444 |
| spellingShingle | Janne Estill Plamenna Venkova-Marchevska Huldrych F. Günthard Sara Botero-Mesa Amaury Thiabaud Maroussia Roelens Laure Vancauwenberghe Lauro Damonti Ulrich Heininger Anne Iten Peter W. Schreiber Rami Sommerstein Sarah Tschudin-Sutter Nicolas Troillet Danielle Vuichard-Gysin Andreas Widmer Torsten Hothorn Olivia Keiser Treatment effect of remdesivir on the mortality of hospitalised COVID-19 patients in Switzerland across different patient groups: a tree-based model analysis Swiss Medical Weekly |
| title | Treatment effect of remdesivir on the mortality of hospitalised COVID-19 patients in Switzerland across different patient groups: a tree-based model analysis |
| title_full | Treatment effect of remdesivir on the mortality of hospitalised COVID-19 patients in Switzerland across different patient groups: a tree-based model analysis |
| title_fullStr | Treatment effect of remdesivir on the mortality of hospitalised COVID-19 patients in Switzerland across different patient groups: a tree-based model analysis |
| title_full_unstemmed | Treatment effect of remdesivir on the mortality of hospitalised COVID-19 patients in Switzerland across different patient groups: a tree-based model analysis |
| title_short | Treatment effect of remdesivir on the mortality of hospitalised COVID-19 patients in Switzerland across different patient groups: a tree-based model analysis |
| title_sort | treatment effect of remdesivir on the mortality of hospitalised covid 19 patients in switzerland across different patient groups a tree based model analysis |
| url | https://smw.ch/index.php/smw/article/view/3444 |
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