A shorter symptom onset to remdesivir treatment (SORT) interval is associated with a lower mortality in moderate-to-severe COVID-19: A real-world analysis

Objectives: Remdesivir is the current recommended anti-viral treatment in moderate-to-severe COVID-19. However, data on impact of timing of therapy, efficacy, and safety are limited. We evaluated the impact of timing of remdesivir initiation (symptom onset to remdesivir treatment [SORT] interval) on in hospital all-cause mortality in patients with moderate-to-severe COVID-19. Methods: This retrospective study was conducted between June 25 and October 3, 2020, at a tertiary care dedicated COVID center in India. Patients with moderate-to-severe COVID-19 (moderate: SpO(2) <94%; severe: SpO(2) <90%) were included. The main outcome was impact of SORT interval on in-hospital all cause mortality. Subgroups were formed and analyzed based on SORT interval. Results: Of 350 patients treated with remdesivir, 346 were included in the final analysis. Overall, 76 (22.0%) patients died (moderate: 3 [2.8%], severe: 73 [30.8%]). All-cause mortality was significantly lower in patients with SORT interval 9 days (n = 260) vs SORT interval 9 days vs 9 days (odds ratio = 0.43; 95% CI, 0.25-0.75; p = 0.003). Conclusion: Remdesivir initiation <9 days from symptom onset was associated with mortality benefit, defining a treatment window and reinforcing the need for appropriately-timed remdesivir in moderate to-severe COVID-19. (C) 2021 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Automated summary

This study evaluated the impact of timing of Remdesivir initiation on in-hospital all-cause mortality in patients with moderate-to-severe COVID-19, finding that initiating Remdesivir treatment within 9 days from symptom onset was associated with a lower mortality rate, highlighting the importance of appropriately-timed Remdesivir treatment.