Treatment effect of remdesivir on the mortality of hospitalised COVID-19 patients in Switzerland across different patient groups : a tree-based model analysis

Article Article scientifique Article Treatment effect of remdesivir on the mortality of hospitalised COVID-19 patients in Switzerland across different patient groups : a tree-based model analysis eng 2023-08-28 2023-08-28 author Estill Janne Anton Markus Institute of Global Health, University of Geneva, Geneva, Switzerland.,School of Basic Medical Sciences, Lanzhou University, Lanzhou, China. 873331 Institut de santé globale (COSPR) author Venkova-Marchevska Plamenna Institute of Global Health, University of Geneva, Geneva, Switzerland. 944304 author Günthard Huldrych F Department of Infectious Diseaes and Hospital Epidemiology, University Hospital Zürich, Zürich, Switzerland.,Institute of Medical Virology, University of Zürich, Switzerland. author Botero Mesa Sara Institute of Global Health, University of Geneva, Geneva, Switzerland. 894905 Institut de santé globale (COSPR) author Thiabaud Amaury Institute of Global Health, University of Geneva, Geneva, Switzerland. 901139 author Roelens Maroussia Institute of Global Health, University of Geneva, Geneva, Switzerland. 828632 author Vancauwenberghe Laure Institute of Global Health, University of Geneva, Geneva, Switzerland. 981271 author Damonti Lauro Department of Infectious Diseases, Bern University Hospital (Inselspital), Bern, Switzerland. author Heininger Ulrich Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland. author Iten Anne Clemence Marie Service of Prevention and Infection Control, Directorate of Medicine and Quality, Geneva University Hospitals, Geneva, Switzerland. 31054 author Schreiber Peter W Department of Infectious Diseaes and Hospital Epidemiology, University Hospital Zürich, Zürich, Switzerland. author Sommerstein Rami Department of Infectious Diseases, Bern University Hospital (Inselspital), Bern, Switzerland.,Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland. author Tschudin-Sutter Sarah Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland. author Troillet Nicolas Service of Infectious Diseases, Central Institute, Valais Hospitals, Sion, Switzerland. author Vuichard-Gysin Danielle Department of Infectious Diseases, Thurgau Hospital Group, Muensterlingen and Frauenfeld, Switzerland. author Widmer Andreas Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland. author Hothorn Torsten Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland. author Keiser Olivia 0000-0001-8191-2789 Institute of Global Health, University of Geneva, Geneva, Switzerland. 873427 Institut de santé globale (COSPR) 40095 10.57187/smw.2023.40095 37769356 1424-3997 https://smw.ch/index.php/smw/article/view/3444 Aims of the study: Remdesivir has shown benefits against COVID-19. However, it remains unclear whether, to what extent, and among whom remdesivir can reduce COVID-19-related mortality. We explored whether the treatment response to remdesivir differed by patient characteristics. Methods: We analysed data collected from a hospital surveillance study conducted in 21 referral hospitals in Switzerland between 2020 and 2022. We applied model-based recursive partitioning to group patients by the association between treatment levels and mortality. We included either treatment (levels: none, remdesivir within 7 days of symptom onset, remdesivir after 7 days, or another treatment), age and sex, or treatment only as regression variables. Candidate partitioning variables included a range of risk factors and comorbidities (and age and sex unless included in regression). We repeated the analyses using local centring to correct the results for the propensity to receive treatment. Results: Overall (n = 21,790 patients), remdesivir within 7 days was associated with increased mortality (adjusted hazard ratios 1.28-1.54 versus no treatment). The CURB-65 score caused the most instability in the regression parameters of the model. When adjusted for age and sex, patients receiving remdesivir within 7 days of onset had higher mortality than those not treated in all identified eight patient groups. When age and sex were included as partitioning variables instead, the number of groups increased to 19-20; in five to six of those branches, mortality was lower among patients who received early remdesivir. Factors determining the groups where remdesivir was potentially beneficial included the presence of oncological comorbidities, male sex, and high age. Conclusions: Some subgroups of patients, such as individuals with oncological comorbidities or elderly males, may benefit from remdesivir. Aged Male Humans Switzerland / epidemiology COVID-19 COVID-19 Drug Treatment Hospitals Antiviral Agents / therapeutic use Dewey 613 Swiss National Science Foundation Understanding the HIV epidemic in Malawi: integrating quantitative and qualitative data in a mathematical model 163878 CH Careers European Commission ENDING COVID 19 VARIANTS OF CONCERN THROUGH COHORT STUDIES: END-VOC 101046314 END-VOC EU HE 66 Institut de santé globale 22A1 false 1246 Maladies infectieuses et modèles mathématiques 988 Swiss medical weekly 153 0a7ec698-91a2-451d-8c63-4c2d826ab745 Article (Published version) Public Article-scientifique-from-unpaywall.pdf 3848482 application/pdf CC BY-4.0 ff56fa034feb06be90deeb953eaaf1f79283f4b5b529a54a59f193b3cde04d07 openAccess Faculté de médecine / Section de médecine clinique / Département de santé et médecine communautaires / Institut de santé globale

Title	Published in	Year	Views	Downloads

Treatment effect of remdesivir on the mortality of hospitalised COVID-19 patients in Switzerland across different patient groups : a tree-based model analysis	Swiss medical weekly	2023	85	56
Future scenarios for the SARS-CoV-2 epidemic in Switzerland: an age-structured model	F1000Research	2020	388	103

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