Time-varying characteristics of remdesivir-treated patients hospitalised due to COVID-19: an electronic health record study

Background: Remdesivir is a pivotal antiviral treatment introduced during the COVID-19 pandemic, and its use has changed over time. This provided an opportunity to study how drug usage evolves over the course of a pandemic. Our study aimed to examine key physiological parameters of patients hospitalised due to COVID-19, how the characteristics of patients evolved, and explore if potential differences were similar across time for patients treated with remdesivir and those not treated. Methods: This study sourced electronic health care records from the Capital Region of Denmark. Patients aged ≥12 years hospitalised for the first time due to COVID-19 between 4 June 2020 and 1 December 2021 were included. Three time periods based on World Health Organization (WHO) treatment recommendations were used to describe temporal changes in the propensity score for remdesivir treatment as well as in individual patient characteristics. Results: In total, 6960 patients were included. The key differences between remdesivir-treated (n = 2557) and non-treated (n = 4403) were an elevated c-reactive protein (CRP) (median of 79 vs. 35 mg/L) and increased use of glucocorticoids (41.5% vs. 10%) and antithrombotics (48.5% vs. 18.5%). When describing the temporal changes in the propensity score, there was an overall significant interaction between the time period and exposure group. From the first to the middle period for the non-treated there was a significant increase in the mean propensity score of 0.04 (95% confidence interval (CI) = 0.02-0.06). The patient characteristics that had the largest temporal variations for remdesivir-treated patients were age, alanine transaminase, mechanical ventilation, interleukin-6 inhibitors, glucocorticoids, and antithrombotics. Conclusions: In conclusion, we found that remdesivir-treated and non-treated patients exhibited distinct sociodemographic and physiological characteristics. Also, the use of other COVID-19 treatments evolved differently between remdesivir-treated and not treated over time.