Temporal Improvement Seen in Standard of Care for Hospitalized COVID-19 Patients

WEDNESDAY, Nov. 30, 2022 (HealthDay News) — A temporal improvement in COVID-19 standard of care (SOC) has been suggested, which explains improved outcomes from Adaptive COVID-19 Treatment Trial (ACTT)-2 to ACTT-3, according to a study published online Nov. 29 in the Annals of Internal Medicine.

Gail E. Potter, Ph.D., from the National Institutes of Health in Rockville, Maryland, and colleagues used data from the ACTT to examine whether recovery and mortality improved as SOC evolved. ACTT was a series of trials that assessed COVID-19 therapeutics from February 2020 through May 2021: ACTT-1 compared remdesivir plus SOC to placebo plus SOC, while in ACTT-2 and ACTT-3, the control group was remdesivir plus SOC. Recovery and mortality were compared in sequential cohorts of patients receiving remdesivir plus SOC. In ACTT-3 and ACTT-4, the analysis was repeated for patients receiving remdesivir plus dexamethasone plus SOC. Data were included from adults hospitalized with COVID-19 from 94 hospitals in 10 countries.

The researchers found that the outcomes were better in ACTT-2 than ACTT-1, but the adjusted hazard ratios were close to 1 for recovery and mortality. Compared with ACTT-1, comparable patients in ACTT-2 were less likely to be intubated (odds ratio, 0.75), and there was a reduction seen in hydroxychloroquine use. From ACTT-2 to ACTT-3, outcomes improved (hazard ratio for recovery, 1.43; hazard ratio for mortality, 0.45). Potential explanatory factors were similar between ACTT-2 and ACTT-3, although dexamethasone use increased (11 to 77 percent). In ACTT-3 and ACTT-4, outcomes were similar.

“These findings support the exclusion of nonconcurrent controls when analyzing data from platform trials, particularly for COVID-19 treatments and vaccines,” the authors write.

Several authors disclosed financial ties to pharmaceutical companies, including Gilead, the manufacturer of remdesivir.

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