Effective real-world outcomes of remdesivir provided under compassionate access for moderate/severe COVID-19 in Australia.

Background: Remdesivir is a nucleotide analogue with in vitro activity against SARS-COV-2. Clinical trial data from the ACTT-1 randomised clinical trial demonstrated improved time to clinical recovery. The effectiveness and safety in a real world setting in Australia are unknown.

Aim: To evaluate real-world clinical outcomes in an Australian setting.

Methods: Retrospective chart review in a tertiary care setting of patients who received remdesivir under compassionate access in 10 Australian hospitals between July and December 2020. The primary outcome was time to recovery, as defined on an ordinal scale by discharge or hospitalisation no longer requiring any acute medical care. Secondary outcomes including 28-day mortality were also measured and compared to data from ACTT-1.

Results: Data were collected on 220 patients. The average age was 61 years (range 23-96); 76 (34%) patients had diabetes, 45 (20%) had pre-existing lung disease, and 21 (9%) were immunosuppressed; 214 (96%) patients were hypoxic at any point during the admission, and 51 (22%) patients required mechanical ventilation. Mean duration of symptoms to commencement of remdesivir was 7 days (range 0-14), while 213 (95%) received glucocorticoids. Median time to improvement on remdesivir was 4 days, compared to 7 days in patients receiving remdesivir in ACTT-1. The 28-day mortality was 9%, compared to 11% in ACTT-1.

Conclusion: Clinical recovery and mortality with remdesivir in a real-world setting were at least comparable to randomised clinical trial data, confirming effectiveness in this setting. Use of adjunctive glucocorticoids in this cohort likely contributed to the improved outcomes.