A shorter symptom onset to remdesivir treatment (SORT) interval is associated with a lower mortality in moderate-to-severe COVID-19: A real-world analysis

Objectives: Remdesivir is the current recommended anti-viral treatment in moderate-to-severe COVID-19. However, data on impact of timing of therapy, efficacy, and safety are limited. We evaluated the impact of timing of remdesivir initiation (symptom onset to remdesivir treatment [SORT] interval) on in-hospital all-cause mortality in patients with moderate-to-severe COVID-19.

Methods: This retrospective study was conducted between June 25 and October 3, 2020, at a tertiary care dedicated COVID center in India. Patients with moderate-to-severe COVID-19 (moderate: SpO₂ <94%; severe: SpO₂ <90%) were included. The main outcome was impact of SORT interval on in-hospital all-cause mortality. Subgroups were formed and analyzed based on SORT interval.

Results: Of 350 patients treated with remdesivir, 346 were included in the final analysis. Overall, 76 (22.0%) patients died (moderate: 3 [2.8%], severe: 73 [30.8%]). All-cause mortality was significantly lower in patients with SORT interval ≤9 days (n = 260) vs SORT interval >9 days (n = 86; 18.1% vs 33.7%; p = 0.004). The odds of death were significantly lower in patients with SORT interval ≤9 days vs >9 days (odds ratio = 0.43; 95% CI, 0.25-0.75; p = 0.003).

Conclusion: Remdesivir initiation ≤9 days from symptom onset was associated with mortality benefit, defining a treatment window and reinforcing the need for appropriately-timed remdesivir in moderate-to-severe COVID-19.