Grundmann, Alexander, Wu, Chieh-Hsi, Hardwick, Marc, Baillie, Kenneth, Openshaw, Peter, Semple, Malcolm 
ORCID: 0000-0001-9700-0418, Böhning, Dankmar, Pett, Sarah, Michael, Benedict ORCID: 0000-0002-8693-8926, Thomas, Rhys ORCID: 0000-0003-2062-8623 et al (show 1 more authors)
(2022)
Impact of Dexamethasone and Remdesivir on Neurological Complications during COVID-19.
SSRN Electronic Journal.
Abstract
Importance: Neurological complications are common following acute COVID-19, causing significant morbidity with health economic consequences. However, no treatment studies in COVID-19 focussing on neurological complications have been published to date.<br> <br>Objective: Does treatment with either remdesivir, dexamethasone or both reduce the risk of neurological complications in adult patients hospitalised with COVID-19?<br> <br>Design and setting: COVID-19 neurological complications, and remdesivir and dexamethasone use, were studied in adults admitted to hospitals in the UK with COVID-19, using data from the International Severe Acute and emerging Respiratory Infection Consortium (ISARIC) WHO Clinical Characterisation Protocol UK (CCP-UK, study registration ISRCTN66726260). Treatment allocation was non-blinded and performed by reporting clinicians. A propensity scoring methodology was used to correct for confounding between treatment groups. <br><br>Participants: 89,297 patients aged 18 years and older with laboratory confirmed SARS-CoV-2 infection were eligible for inclusion. Patients requiring supplemental oxygen at any point during admission (n=64,088) were defined as having severe COVID-19, as per WHO criteria. Patients were excluded if they received a dose of any SARS-CoV-2 vaccine or contracted COVID-19 in hospital.<br> <br>Exposures: Treatment with remdesivir, dexamethasone or both was assessed against standard of care. <br> <br>Main outcome(s) and measure(s): A neurological complication (stroke, seizure, meningitis/encephalitis or any other neurological complication) occurring at the point of death, discharge, or resolution of the COVID-19 clinical episode. <br> <br>Results: The median age of patients was 71 (IQR, 56 to 82). 56% were identified as male and 71% were of white ethnicity. 4,408 patients (4.7%) developed neurological complications. In patients with severe COVID-19, neurological complications were associated with increased mortality (OR 1.36, 95% CI 1.25 to 1.47), intensive care admission (OR 1.54, 95% CI 1.41 to 1.6), likelihood of worse self-care on discharge (OR 3.79, 95% CI 3.36 to 4.26) and an increased time to recovery (9.65 days, 95% CI 7.12 to 12.17 days). Treatment with dexamethasone (n=21,129), remdesivir (n=1,428) and both treatments combined (n=10,846) in severe COVID-19 were associated with a reduced incidence of neurological complications; OR 0.76 (95% CI 0.69 to 0.83); OR 0.68 (95% CI 0.51 to 0.90); OR 0.54, (95% CI 0.47 to 0.61) respectively. <br> <br>Conclusions and relevance: Treatment with dexamethasone, remdesivir or both in patients hospitalised with COVID-19 was associated with reduced neurological complications in an additive manner, such that the greatest benefit was observed in patients who received both drugs together. The potential of these treatments to reduce neurological disability is of urgent importance to patients, healthcare systems and public health bodies.<br>
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | COVID-19, dexamethasone, neurological complications, remdesivir, SARS-CoV-2 |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 17 Nov 2022 09:21 |
| Last Modified: | 14 Mar 2024 19:42 |
| DOI: | 10.2139/ssrn.4065552 |
| Open Access URL: | https://papers.ssrn.com/sol3/papers.cfm?abstract_i... |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3166245 |
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