Introduction
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus
that causes coronavirus disease 2019 (COVID-19), continues to cause
morbidity and mortality globally.1 Evidence-supported
treatment for COVID-19 include small molecule antiviral drugs,
anti-spike neutralizing monoclonal antibodies and immunomodulatory
agents.2 Remdesivir, a direct-acting nucleotide
inhibitor of SARS-CoV-2 RNA-dependent RNA polymerase, was the first
antiviral drug approved for clinical use, and remains as backbone for
treatment of hospitalized patients with COVID-19.3-5
Remdesivir has been demonstrated to be effective for treatment of
hospitalized patients with severe disease and high-risk outpatients with
mild COVID-19. A phase 3 trial showed that a 5-day course of remdesivir
shortened recovery time among hospitalized patients with
COVID-19.4,6,7 [4, 6, 7]. Among non-hospitalized
outpatients with conditions that predisposes to severe disease
progression, a 3-day course of remdesivir reduced the rates of
hospitalization or death by 87% compared to placebo.8
Prior to 2022, remdesivir was only approved for clinical use in hospital
settings.9 At the Mayo Clinic, most patients remained
hospitalized for a minimum of 5 days to complete the course of
remdesivir treatment. Patients who improved clinically often expressed
desire to leave the hospital prior to completion of the 5-day course of
remdesivir. However, the outcome of the abbreviated course of remdesivir
was not known. In November 2021, our program developed hospital-based
infusion therapy centers to allow for earlier dismissal of hospitalized
patients who had achieved clinical improvement. By allowing early
dismissal of stable improving hospitalized patients, the healthcare
system would benefit by making hospital rooms and staff available for
sicker patients.
In this study, we report the outcomes of patients with COVID-19 treated
with remdesivir across the continuum of care. We aim to describe the
characteristics and outcomes of patients who were transitioned to
complete remdesivir in the hospital-based outpatient setting and assess
their risk of mortality and 28-day re-admission rates.