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Early Remdesivir for Patients Who Are Immunocompromised and Hospitalized With COVID-19

Year: 2026

Type: article

Abstract: Background: Patients who were immunocompromised were largely excluded from COVID-19 clinical trials, and real-world evidence on remdesivir effectiveness has produced conflicting results. We evaluated whether early remdesivir initiation (vs late or never) reduces in-hospital mortality among patients who are immunocompromised and hospitalized with COVID-19. Methods: We conducted a retrospective cohort study using a target trial emulation framework with clone-censor-weighting and deidentified hospital chargemaster data combined with medical and pharmacy claims from approximately 400 US hospitals. Patients included those who were immunocompromised, aged ≥12 years, and hospitalized for COVID-19 between 1 May 2020 and 3 December 2023. We assessed all-cause in-hospital mortality within 14 and 28 days of admission for 3 remdesivir treatment regimens: initiation within 2 days of admission ("early"), initiation within 3 to 7 days ("late"), and no initiation of remdesivir ("never"). Results: Among 97 587 eligible patients (median age, 71 years; 51% female), the 14-day cumulative risk of in-hospital mortality was 9.2% for early remdesivir, 10.1% for late, and 11.8% for never. At 14 days, the adjusted relative risk was 0.91 (95% CI, .86-.97) for early vs late initiation and 0.78 (95% CI, .75-.81) for early vs never initiation. At 28 days, trends were similar. Subgroup analyses by age, variant era, and immunosuppression severity yielded similarly protective effects of early initiation of remdesivir. Conclusions: The risk of in-hospital mortality for patients with COVID-19 who were immunocompromised was lower when remdesivir was administered early as compared with late or never. This result was consistent regardless of age, severity of immunosuppression, and variant era.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofag630