Remdesivir treatment plan kept COVID-19 patients hospitalized longer, University of Iowa research shows

A new study has found use of remdesivir, the first medicine approved in the United States to treat COVID-19, may have resulted in longer hospital stays for infected patients.

A University of Iowa researcher led a study published this month that found the antiviral medication is not associated with improved survival among hospitalized patients 30 days after they were discharged.

Instead, data shows the drug regimen may have lengthened hospital stays — contradicting early clinical trials that stated patients would be discharged faster, opening more beds during critical surge periods of the pandemic.

“Whereas (remdesivir) was approved to give people out of the hospital quicker, it seemed to be related to them staying longer,” said Dr. Michael Ohl, professor of internal medicine with University of Iowa Health Care and a physician with the Iowa City Veterans Affairs Health Care System.

The research was published earlier this month in the medical journal, JAMA Network Open.

The study observed 2,344 adults hospitalized with COVID-19 in 123 VA hospitals nationwide, including 1,172 who received remdesivir and 1,172 who did not. These patients were admitted between May 1 and Oct. 8, 2020, during the period the drug had emergency use authorization by the U.S. Food and Drug Administration.

Patients who received remdesivir actually stayed in the hospital three days longer than those who did not, said Ohl, who led the research.

The additional length of stay is not a result of any side effects or health problems caused by the medication. Instead, it may be a result of federal recommendations that the drug is administered over a five- or 10-day course.

Data showed many COVID-19 patients who received remdesivir in the study were discharged exactly five days later, Ohl said, leading to the conclusion that providers were keeping patients admitted to complete the recommended course.

“It’s hard to explain why so many people were going home exactly five days, on the day they completed their remdesivir,” Ohl told The Gazette. “So that’s our hypothesis based on what we saw in the data, but I don’t think we can say definitely what happened.”

Ohl said it is safe for providers to stop administering remdesivir and send a patient home before completing the five-day course if they have recovered.

“It’s reasonable to use remdesivir as it is recommended by the guidelines, but we should just be careful not to keep people in hospital just to complete courses when they are ready to go home,” he said.

Ohl noted the study did have its limitations. Researchers found almost all of the most severely ill patients received remdesivir. It was difficult for researchers to find a control group of the sickest patients who didn’t receive the drug, so they were not included in the study, he said.

That means the study may be generalized to patients who were not as severely ill from a coronavirus infection.

Remdesivir was formally approved for use in adult and pediatric patients by federal health officials in late October. It was developed by the California-based biotech company Gilead Sciences under the brand name Veklury.

The drug’s emergency use authorization was supported by three clinical trials, including one conducted by the National Institute of Allergy and Infectious Diseases. That study found the median recovery time for infected patients was shorter for those who received the antiviral medication.

“A big argument for approving remdesivir was that even if it wasn’t improving survival, it would perhaps allow us to help people get better sooner and be released from the hospital sooner, which would free up more beds to treat more patients,” Ohl said.

“That could potentially be very important during pandemic surges when we have need for beds in the hospital.”

Early clinical trials were conducted in controlled environments, but Ohl said he and other researchers wanted to understand how remdesivir was working in a real-world hospital setting.

Other later studies have shown the drug has no significant clinical benefits. As a result, the World Health Organization issued a recommendation against its use in COVID-19 patients in late November.

As cases continue to spread nationwide and individuals become infected, it’s likely hospitals will continue to look for treatment options for COVID-19 patients. Ohl emphasized the results of this research show it’s still reasonable to use remdesivir, but providers should not keep patients in the hospital solely to continue administering the drug.

“It won’t clearly benefit (patients) and it will cause us to use beds that we could use to treat other patients,” Ohl said.

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