Robert L Gottlieb

Background Remdesivir has demonstrated benefit in some hospitalized patients with COVID-19 on supplemental oxygen and in non-hospitalized patients at room air. The durability of this benefit across time periods with different circulating SARS-CoV-2 variants of concern (VOC) is unknown. This comparative effectiveness study compares inpatient mortality among patients hospitalized for COVID-19 not receiving supplemental oxygen at admission initiating remdesivir treatment in the first two days of admission vs. no remdesivir during the hospitalization across different VOC periods. Method Using a large, multicenter US hospital database, in-hospital mortality was compared among patients hospitalized for COVID-19 not requiring supplemental oxygen at admission between December 2020 and April 2022. Patients receiving remdesivir upon hospital admission were matched 1:1 to those not receiving remdesivir during hospitalization using propensity score matching. Cox proportional hazards models were used to assess 14- and 28-day in-hospital mortality or discharge to hospice. Results Among the 121,336 eligible patients, 58,188 remdesivir-treated patients were matched to 17,574 unique non-remdesivir patients. Overall, 5.4% of remdesivir-treated and 7.3% of non-remdesivir patients died within 14 days, while 8.0% of remdesivir-treated and 9.8% of non-remdesivir patients died within 28 days. Remdesivir treatment was associated with a statistically significant reduction in in-hospital mortality compared to non-remdesivir treatment (14-day adjusted hazard ratio (aHR): 0.75, 95% confidence interval (CI): 0.68-0.83; 28-day aHR: 0.83, 0.76-0.90). This significant mortality benefit endured across the different VOC periods. Conclusions Remdesivir initiation in patients hospitalized for COVID-19, not requiring supplemental oxygen at admission, was associated with a statistically significant reduction in in-hospital mortality. These findings highlight a potential survival benefit when clinicians initiated remdesivir upon admission across the dominant variant eras of the evolving pandemic.