Remdesivir’s effectiveness in treating severe COVID-19—a retrospective cohort from Pakistan

The efficacy of remdesivir in the treatment of severe COVID-19 is contentious, characterized by inconsistent findings regarding mortality benefit and recovery time across clinical trials such as ACTT-1 and WHO Solidarity. The ACTT-1 trial indicated a decrease in recovery time, however the WHO Solidarity trial revealed no substantial mortality advantage. Due to these inconsistencies, additional real-world data are required, especially in resource-constrained environments where treatment regimens may vary. This study assesses the efficacy of remdesivir in conjunction with standard care (R-SOC) versus standard care alone (SOC) in patients presenting with severe COVID-19 pneumonia in Pakistan. From June 2021 to December 2022, all consecutive patients diagnosed with severe COVID-19 pneumonia who were admitted to Dr. Ziauddin Hospital North Nazimabad in Karachi, Pakistan, were included in a retrospective, comparative cohort study. In order to evaluate treatment outcomes, these patients were enrolled in a retrospective, comparative cohort research that included survival analysis. The SOC group had a considerably greater discharge rate compared to the R-SOC group (70.3% vs. 57.4%; p < 0.001). The fatality rate was notably higher in the R-SOC group than in the SOC group (35% vs. 19%; p = 0.001). Furthermore, compared to the SOC group, a greater percentage of patients in the R-SOC group needed invasive mechanical ventilation or admission to the intensive care unit (ICU) (24.8% vs. 10.5%; p = 0.001, and 13% vs. 5.6%; p = 0.001, respectively). Patients receiving SOC were also discharged sooner than those receiving R-SOC (6.23 vs. 8.38 days; Log Rank p = 0.001). Accordingly, patients in the R-SOC group had a substantially increased risk of mortality (HR 2.082, 95% CI 1.603–2.704, p = 0.001), ICU admission (HR 1.603, 95% CI 1.143–2.248, p = 0.006), and invasive mechanical ventilation (HR 2.717, 95% CI 1.661–4.442, p = 0.001). Remdesivir use was associated with the higher rates of intensive care unit admission, a longer hospital stay, a higher requirement for invasive mechanical ventilation, and an increased risk of death.