Background
Immunocompromised patients who are hospitalized with COVID-19 and initiate remdesivir (RDV) within the first 2 days of hospitalization have a lower risk of all-cause mortality than those who do not initiate RDV. However, it is unknown what proportions of patients with immunocompromising conditions (when stratified by age or the SARS-CoV-2 variant period) initiate RDV at different stages of hospitalization (ie, early, intermediate, late, or never).
Methods
This was a retrospective observational cohort study using HealthVerity data, which includes US hospital chargemaster data and hospital, medical, and pharmacy claims. Patients with immunocompromising conditions aged ≥12 years who were hospitalized between May 2020 and December 2023 with a primary diagnosis of COVID-19 were evaluated by time of RDV initiation after hospital admission: 1-2 days (early), 3-7 days (intermediate), ≥8 days (late), or never; day 1 = day of admission. Analyses were stratified by age and variant period (initial wave: May 1, 2020-May 31, 2021; Delta: June 1, 2021-November 30, 2021; Omicron: December 1, 2021-December 3, 2023).
Results
Among the 154,850 eligible patients identified, median (Q1, Q3) age was 71 (60, 80) years. Among the 54,238/154,850 (35%) patients who initiated RDV during hospitalization, 46,198/54,238 (85%) patients started RDV within 1-2 days of admission (Table 1). Among those who received RDV in the hospital, the proportion of patients who initiated RDV within 1-2 days of hospitalization was comparable between those aged 12-64 and >65 years (15,767/17,992 [88%] and 30,431/36,246 [84%], respectively), as well as across the variant periods (initial wave: 18,359/22,261[82%]; Delta: 8608/9533 [90%]; Omicron: 19,231/22,444 [86%]). However, most (100,612/154,850 [65%]) patients never initiated RDV; this was also true among the subset of patients aged >65 years (65,926/102,172 [65%] did not initiate RDV) and those who had COVID-19 during the Omicron period (50,307/72,751 [69%] did not initiate RDV).
Conclusions
While most patients with immunocompromising conditions who received RDV were treated within 1-2 days of hospital admission, the majority were never treated, suggesting an opportunity to prevent disease progression in one of the highest risk groups.
Table or Figure
