Remdesivir versus usual care in the treatment of patients with COVID-19

Background Remdesivir was approved by the Food and Drug Administration in 2020 for treating hospitalized COVID-19 patients and those at high risk of severe disease. Although studies have shown a reduced risk of severe outcomes during the Omicron era compared to earlier variants, data on the effectiveness of remdesivir during this period remains limited. Objective To evaluate the clinical benefit of remdesivir in comparison to no antiviral therapy for the treatment of more recent COVID-19 infections. Methods This retrospective cohort study included patients admitted to seven hospitals in central Florida between January 2023 and December 2024. Patients included had a primary diagnosis of COVID-19 and required ≥ 2 liters of nasal cannula oxygen for a minimum of 24 hours. Patients requiring higher levels of oxygen support were excluded. The primary outcome was the progression of oxygen supplementation requirements. Data were analyzed using REDCap® and SPSS®. Results A total of 120 patients received remdesivir, and 52 patients received usual care (nasal cannula support ± steroids). The median age was 77 years (IQR: 67-85) with hypertension, chronic pulmonary disease, and diabetes as common comorbidities. No difference in progression of oxygen supplementation was observed between remdesivir (19 [15.8%] versus 7 [13.5%] usual care, p=0.16). Post-hoc analysis demonstrated Charlson Comorbidity Index was significantly associated with oxygen support progression (OR 1.98 [1.07-3.68] p=0.03). Conclusion Remdesivir did not result in a reduction in oxygen supplementation progression in hospitalized COVID-19 patients during the Omicron era. Further large-scale prospective studies are needed to validate these findings.