(532) Addition of Remdesivir to Dual-Therapy Dexamethasone and Baricitinib or Tocilizumab for COVID-19

Introduction: In patients hospitalized with COVID-19, little is known about the addition of remdesivir to corticosteroids and tocilizumab or baricitinib. The objective of this study was to evaluate the efficacy and safety of triple therapy, remdesivir with corticosteroids and tocilizumab or baricitinib, versus dual therapy, corticosteroids and tocilizumab or baricitinib.

Methods: This was a single-centered, retrospective cohort study of patients who were 18 years and older, admitted with COVID-19 between January 1, 2021 and June 30, 2022, and received dual therapy (defined as a corticosteroid with one dose of tocilizumab or greater than or equal to three doses of baricitinib during the index hospitalization). Patients were excluded if they were pregnant, on mechanical ventilation, immunocompromised, or received both tocilizumab and baricitinib. The primary outcome was progression to mechanical ventilation or in-hospital mortality on discharge. Secondary outcomes included individual components of the primary outcome, hospital length of stay, intensive care unit length of stay, acute kidney injury, bradycardia, or acute liver injury during hospitalization.

Results: Of the 258 patients in the study, 148 received triple therapy, and 110 received dual therapy. The primary outcome occurred in 60 patients (40.5%) in the triple therapy group and 42 patients (38.2%) of patients in the dual therapy group (p=0.702). Patients on triple therapy had trends towards longer lengths of stay. Patients in the triple therapy group were more likely to have bradycardia (p=0.031).

Conclusions: There was no difference in progression to mechanical ventilation or in-hospital mortality in patients receiving dual therapy versus triple therapy with COVID-19, but there were higher rates of bradycardia in patients receiving triple therapy.