'Early Remdesivir Initiation Linked to Lower In-Hospital Mortality in Immunocompromised Covid Patients'

 Among immunocompromised patients hospitalized with COVID, initiating remdesivir on the day of admission or the next day was associated with a reduction of about 22% in in-hospital mortality at 14 days compared with never initiating it. Early initiation also was linked to lower mortality than later initiation.

METHODOLOGY

• Researchers conducted a retrospective observational cohort study using deidentified data from about 400 hospitals in the United States between May 2020 and December 2023.
• A total of 97,587 patients aged ≥ 12 years with a qualifying immunosuppressive condition and a primary admitting diagnosis of COVID were included; 39,315 initiated remdesivir early (day 1 or 2), 4432 late (days 3-7), and 53,471 never. 
• Solid malignancy treated within the past year and rheumatologic or inflammatory conditions such as multiple sclerosis, lupus erythematosus, and rheumatoid arthritis were among the immunosuppressive conditions included in the study.
• Patients were followed for up to 28 days from admission, and the primary outcome was all-cause in-hospital mortality. The secondary outcome was a composite of in-hospital mortality or initiation of mechanical ventilation or extracorporeal membrane oxygenation (ECMO).

TAKEAWAY

• Adjusted 14-day cumulative mortality was 9.2% (95% CI, 8.9%-9.5%) with early initiation of remdesivir, 10.1% (95% CI, 9.6%-10.6%) with late initiation, and 11.8% (95% CI, 11.5%-12.2%) for those who never received the therapy; 28-day risks were 13.7%, 14.5%, and 16.6%, respectively.
• At 14 days, the adjusted relative risk (aRR) was 0.78 (95% CI, 0.75-0.81) for early vs never and 0.91 (95% CI, 0.86-0.97) for early vs late initiation of treatment with the intravenous antiviral medication.
• For the composite of death, mechanical ventilation, or ECMO, 14-day risks were 12.4%, 12.9%, and 14.4% for early, late, and never initiation. The aRR was 0.86 (95% CI, 0.83-0.89) for early vs never initiation, and for early vs late treatment it was 0.96 (95% CI, 0.91-1.00).

IN PRACTICE

"Of note, nearly 55% of patients never initiated remdesivir during their hospitalization, even though it was FDA approved and guideline recommended during the study period, underscoring an opportunity to improve clinical outcomes by utilizing all available therapies," wrote the authors of the study.

SOURCE

Kathleen E. Hurwitz, ScD, with Headwater Science in Durham, North Carolina, and Joshua A. Hill, MD, with Fred Hutchinson Cancer Center, Seattle, Washington, were the corresponding authors for the study, which was published online on November 4, 2026, in Open Forum Infectious Diseases.

LIMITATIONS

The researchers could not adjust for patients' COVID vaccination status. The recorded timing of in-hospital treatments may be imprecise. Few patients had severe immunosuppression.

DISCLOSURES

Several authors are employees of Gilead Sciences, the company that developed remdesivir. Other researchers have consulted for and received research funding from Gilead and other pharmaceutical companies.

https://www.medscape.com/viewarticle/early-remdesivir-initiation-linked-lower-hospital-mortality-2026a10016pc