COVID patients who don’t receive remdesivir not more likely to die, data suggest

A study at a Minnesota healthcare system finds that limiting the use of the antiviral drug remdesivir (Veklury) in hospitalized COVID-19 patients didn’t result in a greater risk of death.

“There is limited data to support routine remdesivir use in the contemporary era of SARS-CoV-2 with widespread seropositivity [evidence of previous infection or vaccination],” the HealthPartners researchers wrote.

The team compared COVID-19 patients’ 14-day risk of death 12 months before and after implementation of remdesivir restrictions at the system’s eight hospitals (June 2022 to May 2023 and July 2023 to June 2024, respectively). Of the 4,774 patients with healthy immune systems included in the analysis, 3,323 and 1,451 participated before and after the intervention, respectively.

The findings were published late last week in Clinical Infectious Diseases.

No difference in death, readmission, hospital stay

Significantly fewer patients in the post-implementation group were given remdesivir (37.7% pre-intervention vs 4.1% post-intervention). Models of medium-risk covariates found no difference in 14-day all-cause death rates between the two groups (odds ratio, 1.8; 95% confidence interval, 0.54 to 5.8) or in 28-day all-cause death rates, 30-day readmissions, or length of hospital stay. 

Remdesivir use was associated with an unexpected increased risk of ICU admission and MV within the post-intervention group only, which is likely explained by the higher-risk patient population that received remdesivir.

But remdesivir use was linked to a lower risk of intensive care unit (ICU) admission and need for mechanical ventilation (MV) before the intervention and a higher risk of these outcomes after.

“Remdesivir use was associated with an unexpected increased risk of ICU admission and MV within the post-intervention group only, which is likely explained by the higher-risk patient population that received remdesivir,” the study authors wrote. “Prospective studies would be needed to definitively determine if highly vaccinated, immunocompetent patients benefit from remdesivir.”