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Dexamethasone, dexamethasone + remdesivir in treating moderate to severe COVID-19: retrospective observational cohort
Nithish Sattoju1, Santosh Gattu1, Sai Sashank Merugu1
1Medisys Hospitals, LB nagar, Hyderabad, Telangana, India.
Insights
Adding remdesivir to dexamethasone for COVID-19 treatment showed no additional benefits. The antiviral did not improve outcomes beyond dexamethasone alone, except for a potential 10-day survival advantage in specific patient subgroups.
Area of Science:
- Infectious Diseases
- Pharmacology
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) treatment has evolved, with dexamethasone and remdesivir being key therapeutic agents.
- The synergistic or additive effects of combining antiviral (remdesivir) and anti-inflammatory (dexamethasone) therapies for COVID-19 remain an area of clinical investigation.
Purpose of the Study:
- To evaluate the efficacy of adding remdesivir to dexamethasone therapy in patients with moderate to severe COVID-19.
- To determine if combination therapy offers superior clinical outcomes compared to dexamethasone monotherapy.
Main Methods:
- A retrospective observational cohort study design was employed.
- Patients were stratified into two groups: dexamethasone alone and dexamethasone plus remdesivir.
- Clinical data, including inflammatory markers, WHO ordinal scale, symptom resolution, and 10-day outcomes (mortality, discharge status), were analyzed.
Main Results:
- Combination therapy with remdesivir and dexamethasone did not demonstrate significant additional benefits over dexamethasone alone for most clinical parameters.
- A potential improvement in 10-day outcomes was observed with remdesivir, possibly confounded by patient selection (mechanical ventilation status).
- No substantial differences were noted in inflammatory markers, WHO scores, or symptomatic improvement between the groups.
Conclusions:
- The addition of remdesivir to dexamethasone therapy does not appear to provide significant additional benefits in treating COVID-19.
- Further research may be needed to identify specific patient subgroups who might benefit from combination therapy.
- Current evidence suggests dexamethasone monotherapy may be sufficient for many patients with moderate to severe COVID-19.
Introduction:
The aim of this study was to demonstrate the purpose of adding antiviral (remdesivir) to the existing steroidal (dexamethasone) therapy in treating coronavirus disease 2019 (COVID-19).
Methodology:
A retrospective observational case cohort study was carried out to compare the effect of dexamethasone alone and in combination with remdesivir in treating moderate and severe COVID-19 disease. The patients were divided into 2 groups: Group 1 included patients treated with dexamethasone alone, and Group 2 included patients treated with dexamethasone and remdesivir. Levels of inflammatory markers (C-reactive protein, D- dimer and lactate dehydrogenase), World Health Organization (WHO) ordinal scale scoring, symptomatic improvement in terms of fever, cough, shortness of breath, 6-minutes' walk test and SpO2 levels on day of admission (D0), 3 days and 5 days after admission (D3 and D5), and 10 days overall outcome (determined as death, or discharge with or without Long Term Oxygenation Therapy) were collected and analyzed.
Results:
Addition of remdesivir to dexamethasone in treating COVID 19 did not have any additional benefits. No additional role of remdesivir is seen in combating the disease except in case of 10 days outcome. However, the better 10-day outcome associated with the use of remdesivir was thought to be due to the patients who were on mechanical ventilation in the dexamethasone treated group at the time of inclusion.
Conclusions:
Since a similar trend was seen in both groups, our study concluded no additional role of remdesivir in combating COVID-19.
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