Retrospective Cohort Study Assessing Remdesivir Effectiveness in Hospitalized COVID-19 Patients With Renal or Hepatic Comorbidities
In brief
Early remdesivir reduces 28-day mortality by about 25% in kidney or liver patients
In a US claims analysis of over 27,000 hospitalized COVID-19 adults with renal or hepatic disease, patients who started remdesivir within the first two days had roughly a one-quarter lower risk of dying within 28 days compared with matched controls. Benefit was seen both in those needing supplemental oxygen and, for liver disease, even without oxygen, suggesting early treatment may improve survival in these high-risk groups.
- Journal
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Q1)
- Published
- 1 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Patrick Godwin, Valentina Shvachko, Thomas Oppelt, Chen-Yu Wang, Amos Lichtman, Mark Berry, et al.
- PMID
- 42677942
- DOI
- 10.1093/cid/ciag534
Why clinicians should know about it
- Picked for Internal Medicine (paper of the day, 3 September 2026): Early remdesivir reduces 28‑day mortality in comorbid patients
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.