Background Patients with immunocompromising conditions are at an increased risk for coronavirus disease 2019 (COVID-19)-related hospitalizations and mortality. Randomized clinical trials provide limited enrollment, if any, to inform outcomes of such patients treated with remdesivir. Methods Using the US PINC AI Healthcare Database, we identified adult patients with immunocompromising conditions, hospitalized for COVID-19 between December 2021 and February 2024. Primary outcome was all-cause inpatient mortality examined in propensity score (PS) matched patients in remdesivir versus non-remdesivir groups. Subgroup analyses were performed for patients with cancer, hematologic malignancies, and solid organ/hematopoietic stem cell transplant recipients. Results Of 28,966 patients included in the study, 16,730 (58%) received remdesivir during first two days of hospitalization. After PS matching, 8,822 patients in remdesivir and 8,822 patients in non-remdesivir group were analyzed. Remdesivir was associated with a significantly lower mortality among patients with no supplemental oxygen (aHR [95% CI]: 14-day, 0.73 [0.62-0.86]; 28-day, 0.79 [0.68-0.91]) and among those with supplemental oxygen (14-day, 0.75 [0.67-0.85]; 28-day, 0.78 [0.70-0.86]). Remdesivir was also associated with lower mortality in subgroups of patients with cancer, hematological malignancies (including leukemia, lymphoma, and multiple myeloma), and solid organ/hematopoietic stem cell transplantation. Conclusions In this large cohort of patients with immunocompromising conditions hospitalized for COVID-19, remdesivir was associated with significant improvement in survival, including patients with varied underlying immunocompromising conditions. The integration of current real-world evidence into clinical guideline recommendations can inform clinical communities to optimize treatment decisions in the evolving COVID-19 era, extending beyond the conclusion of the public health emergency declaration.

中文翻译：

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因 COVID-19 住院的免疫功能低下患者的瑞德西韦相关生存结局：来自 Omicron 主导时代的真实世界证据


背景 免疫功能低下的患者发生 2019 冠状病毒病 （COVID-19） 相关住院和死亡的风险增加。随机临床试验提供有限的入组（如果有），以告知接受瑞德西韦治疗的此类患者的结局。方法 使用 US PINC AI 医疗保健数据库，我们确定了 2021 年 12 月至 2024 年 2 月期间因 COVID-19 住院的免疫功能低下成年患者。主要结局是瑞德西韦组与非瑞德西韦组的倾向评分 （PS） 匹配患者全因住院死亡率。对癌症、血液系统恶性肿瘤和实体器官/造血干细胞移植受者进行亚组分析。结果 在纳入研究的 28,966 名患者中，16,730 名 （58%） 在住院的前两天接受了瑞德西韦治疗。PS 匹配后，分析瑞德西韦组 8,822 例患者和非瑞德西韦组 8,822 例患者。瑞德西韦与无辅助供氧患者 （aHR [95% CI]： 14 天，0.73 [0.62-0.86];28 天，0.79 [0.68-0.91]）和补充氧气患者 （14 天，0.75 [0.67-0.85];28 天，0.78 [0.70-0.86]）的死亡率显著降低相关。瑞德西韦还与癌症、血液系统恶性肿瘤 （包括白血病、淋巴瘤和多发性骨髓瘤） 和实体器官/造血干细胞移植患者亚组的死亡率较低相关。结论 在这一大批因 COVID-19 住院的免疫功能低下患者中，瑞德西韦与生存率的显著改善相关，包括具有不同潜在免疫功能低下疾病的患者。 将当前真实世界证据整合到临床指南建议中，可以为临床社区提供信息，以便在不断发展的 COVID-19 时代优化治疗决策，其范围超出了公共卫生紧急状态宣言的结论。