Retrospective Cohort Study Assessing Remdesivir Effectiveness in Hospitalized COVID-19 Patients With Renal or Hepatic Comorbidities

BACKGROUND: Individuals with COVID-19 who have underlying renal or hepatic comorbidities are at a higher risk of mortality than those without these comorbidities. Real-world data on the effectiveness of early remdesivir (RDV) initiation in these populations are limited. This study evaluated the effect of early RDV initiation on 28-day all-cause in-hospital mortality among patients in the US who were hospitalized for COVID-19 and had renal or hepatic comorbidities. METHODS: This retrospective comparative effectiveness study used patient-level medical claims and hospital chargemaster data in the US (2021-2025). Adults who received early RDV were compared with those who did not. Patients were stratified by supplemental oxygen use in the first 2 days of hospitalization. The primary endpoint was risk of 28-day all-cause in-hospital mortality, estimated using Cox proportional hazards models. RESULTS: After 1:1 propensity score matching, 22,378 patients were included in the renal cohort (11,189 per group) and 5026 patients were included in the hepatic cohort (2513 per group). There was a reduced risk of 28-day all-cause in-hospital mortality with early RDV in both the renal cohort (HR: 0.75 [95% CI: 0.68, 0.83]; P <0.01) and the hepatic cohort (HR: 0.76 [95% CI: 0.60, 0.95]; P = 0.02). The risk of mortality was significantly lower with early RDV initiation among patients who received supplemental oxygen in both cohorts and among patients in the hepatic cohort who did not receive supplemental oxygen. CONCLUSION: Early RDV initiation was associated with improved survival among patients with renal or hepatic disease who were hospitalized for COVID-19.