Comparative Effectiveness of Remdesivir in Hospitalized COVID-19 Patients: A Retrospective Cohort Study From the Pre-vaccination and Omicron Eras.

BACKGROUND

The real-world effectiveness of remdesivir for COVID-19 pneumonia remains a subject of debate, particularly across different phases of the pandemic. This study compares clinical outcomes and inflammatory biomarker profiles in hospitalized patients treated with remdesivir during two distinct periods: the pre-vaccination era in 2020 and the Omicron-dominant, post-vaccination period in 2023.

METHODS

This retrospective observational study was conducted at a tertiary care hospital in Germany. Adults hospitalized with polymerase chain reaction (PCR)-confirmed COVID-19 pneumonia were included from two timeframes: 2020 (n = 154) and 2023 (n = 178). Patients were stratified by remdesivir treatment. The primary outcome was length of hospital stay; secondary outcomes included ICU admission, mechanical ventilation, in-hospital mortality, oxygen requirement, WHO COVID-19 severity grade, and admission inflammatory markers.

RESULTS

In 2020, 38 patients (24.7%) received remdesivir; in 2023, 64 patients (36.0%) were treated with the drug. Remdesivir use was associated with significantly shorter hospital stays among survivors in both periods (2020: median 10 vs. 20 days; 2023: median 7 vs. 13 days; both p < 0.01). Most treated patients required oxygen and met WHO clinical severity grades 4-6. Inflammatory markers at admission were lower in survivors and the 2023 cohort. In-hospital mortality was 16.9% in 2020 and 9.0% in 2023. A trend toward lower mortality was observed in 2023, although not statistically significant.

CONCLUSION

Remdesivir use was consistently associated with reduced hospital stays across both pandemic phases. A potential mortality benefit emerged during the Omicron era, particularly in high-risk patients requiring oxygen, supporting the continued clinical use of remdesivir during periods of high transmission.