Efficacy of remdesivir in Japanese patients hospitalised with COVID-19: A large observational study using the COVID-19 Registry Japan

Objectives Results from several randomised controlled trials comparing the efficacy of remdesivir with placebo have been reported. Data on the efficacy of remdesivir in Asian populations are limited, and conflicting results have been reported. The aim of the present study is to examine whether remdesivir is effective for the treatment of COVID-19 or not. Methods We evaluated the efficacy of remdesivir from data acquired from the COVID-19 Registry Japan, a nationwide registry of Japanese patients hospitalised with COVID-19, using five-to-one propensity score (PS) matching. Primary outcomes were overall risk of fatality, risk of invasive mechanical ventilation or extracorporeal membrane oxygenation (IMV/ECMO) and length of stay (LoS) in healthcare facilities. Results In total, 1907 of 15,225 patients met our inclusion criteria. After PS matching, 74 patients were assigned to the remdesivir case group and 195 patients to the non-remdesivir control group. In a PS-matched cohort, fatality risk (12.2% vs 13.3%; P = 1.0); risk of IMV/ECMO (5.4% vs 4.6%; P = 0.757); length of intensive care unit stay (6 vs 6 days; P = 0.473) and length of IMV (13 vs 5 days; P = 0.509) were not different between the case and control groups. LoS in the case group was longer than in the control group (14 vs 11 days; P < 0.001). Conclusions This study suggested that remdesivir may have no positive effect on clinical outcomes and reductions in invasive/non-invasive respiratory support for patients with COVID-19 in Japan.