Fewer COVID-19 Neurological Complications with Dexamethasone and Remdesivir.



Grundmann, Alexander, Wu, Chieh-Hsi, Hardwick, Marc, Baillie, J Kenneth, Openshaw, Peter JM, Semple, Malcolm G ORCID: 0000-0001-9700-0418, Böhning, Dankmar, Pett, Sarah, Michael, Benedict D ORCID: 0000-0002-8693-8926, Thomas, Rhys H
et al (show 2 more authors) (2022) Fewer COVID-19 Neurological Complications with Dexamethasone and Remdesivir. Annals of neurology, 93 (1). pp. 88-102.

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Abstract

<h4>Objective</h4>The objective of this study was to assess the impact of treatment with dexamethasone, remdesivir or both on neurological complications in acute coronavirus diease 2019 (COVID-19).<h4>Methods</h4>We used observational data from the International Severe Acute and emerging Respiratory Infection Consortium World Health Organization (WHO) Clinical Characterization Protocol, United Kingdom. Hospital inpatients aged ≥18 years with laboratory-confirmed severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection admitted between January 31, 2020, and June 29, 2021, were included. Treatment allocation was non-blinded and performed by reporting clinicians. A propensity scoring methodology was used to minimize confounding. Treatment with remdesivir, dexamethasone, or both was assessed against the standard of care. The primary outcome was a neurological complication occurring at the point of death, discharge, or resolution of the COVID-19 clinical episode.<h4>Results</h4>Out of 89,297 hospital inpatients, 64,088 had severe COVID-19 and 25,209 had non-hypoxic COVID-19. Neurological complications developed in 4.8% and 4.5%, respectively. In both groups, neurological complications were associated with increased mortality, intensive care unit (ICU) admission, worse self-care on discharge, and time to recovery. In patients with severe COVID-19, treatment with dexamethasone (n = 21,129), remdesivir (n = 1,428), and both combined (n = 10,846) were associated with a lower frequency of neurological complications: OR = 0.76 (95% confidence interval [CI] = 0.69-0.83), OR = 0.69 (95% CI = 0.51-0.90), and OR = 0.54 (95% CI = 0.47-0.61), respectively. In patients with non-hypoxic COVID-19, dexamethasone (n = 2,580) was associated with less neurological complications (OR = 0.78, 95% CI = 0.62-0.97), whereas the dexamethasone/remdesivir combination (n = 460) showed a similar trend (OR = 0.63, 95% CI = 0.31-1.15).<h4>Interpretation</h4>Treatment with dexamethasone, remdesivir, or both in patients hospitalized with COVID-19 was associated with a lower frequency of neurological complications in an additive manner, such that the greatest benefit was observed in patients who received both drugs together. ANN NEUROL 2022.

Item Type: Article
Uncontrolled Keywords: ISARIC4C investigators
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 09:17
Last Modified: 20 Jan 2023 01:03
DOI: 10.1002/ana.26536
Open Access URL: https://doi.org/10.1002/ana.26536
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3166247