OBJECTIVES: Remdesivir is an antiviral drug approved for the treatment of COVID-19 patients requiring hospitalization. Several studies evaluating the effectiveness of remdesivir have yielded conflicting results. We aimed to assess the association between the use of remdesivir and key clinical outcomes among hospitalized patients with severe COVID-19.

METHODS: This retrospective analysis was conducted using the TriNetX COVID-19 Network, which provides access to electronic health records from approximately 90 million patients from 66 Healthcare Organizations. The cohort included individuals hospitalized for severe COVID-19 between March 2020 and October 2021. Severe COVID was defined as an oxygen saturation level of less than 94%. Exposed individuals received remdesivir within 30 days after testing positive for COVID-19. The primary outcome was admission to an intensive care unit (ICU) in the 30 days following their first hospital admission. Secondary outcomes included the receipt of mechanical ventilation and all-cause mortality. Propensity score matching was employed to control for observed baseline confounders. The association between receipt of remdesivir and the outcomes of interest was estimated using logistic regression.

RESULTS: The final matched sample consisted of 13144 patients, with 6572 patients in the remdesivir and non-remdesivir group, respectively. The cohort had an average of 61.3 years (SD=17.3), were 55.9% were males, and 54.5% white. Individuals who received remdesivir within 30 days of hospitalization had a significantly higher odds (1.203; 95%CI:1.112–1.302) of being admitted to the ICU. No significant difference in the odds for mechanical ventilation use (1.015; 95%CI:0.937–1.101) or 30-day mortality (0.979; 95%CI:0.904–1.06) was observed.

CONCLUSIONS: Given the existing conflicting body of evidence in the area, further evaluation is needed to examine the role of remdesivir in the treatment of COVID-19 and understand the drivers of remdesivir’s performance in more diversified clinical settings and various subpopulations.