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.