{
  "abstract": "Background: Patients who were immunocompromised were largely excluded from COVID-19 clinical trials, and real-world evidence on remdesivir effectiveness has produced conflicting results. We evaluated whether early remdesivir initiation (vs late or never) reduces in-hospital mortality among patients who are immunocompromised and hospitalized with COVID-19.\n\nMethods: We conducted a retrospective cohort study using a target trial emulation framework with clone-censor-weighting and deidentified hospital chargemaster data combined with medical and pharmacy claims from approximately 400 US hospitals. Patients included those who were immunocompromised, aged ≥12 years, and hospitalized for COVID-19 between 1 May 2020 and 3 December 2023. We assessed all-cause in-hospital mortality within 14 and 28 days of admission for 3 remdesivir treatment regimens: initiation within 2 days of admission (“early”), initiation within 3 to 7 days (“late”), and no initiation of remdesivir (“never”).\n\nResults: Among 97 587 eligible patients (median age, 71 years; 51% female), the 14-day cumulative risk of in-hospital mortality was 9.2% for early remdesivir, 10.1% for late, and 11.8% for never. At 14 days, the adjusted relative risk was 0.91 (95% CI, .86–.97) for early vs late initiation and 0.78 (95% CI, .75–.81) for early vs never initiation. At 28 days, trends were similar. Subgroup analyses by age, variant era, and immunosuppression severity yielded similarly protective effects of early initiation of remdesivir.\n\nConclusions: The risk of in-hospital mortality for patients with COVID-19 who were immunocompromised was lower when remdesivir was administered early as compared with late or never. This result was consistent regardless of age, severity of immunosuppression, and variant era.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "name": "Kathleen E Hurwitz"
    },
    {
      "name": "Mark Berry",
      "orcid": "0000-0002-8534-2012"
    },
    {
      "name": "EunYoung Lee"
    },
    {
      "name": "Kayla Hendrickson"
    },
    {
      "name": "Nuvan Rathnayaka",
      "orcid": "0000-0002-9839-9261"
    },
    {
      "name": "Valentina Shvachko"
    },
    {
      "name": "Mazin Abdelghany",
      "orcid": "0000-0001-5192-8659"
    },
    {
      "name": "Carrie M Nielson",
      "orcid": "0000-0002-2619-7839"
    },
    {
      "name": "M Alan Brookhart"
    },
    {
      "name": "Anand Chokkalingam"
    },
    {
      "name": "Joshua A Hill",
      "orcid": "0000-0002-7665-7100"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/387sfsad3peyg.bib",
  "cited_by": 0,
  "doi": "10.1093/ofid/ofag630",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13732734/",
  "id": "387sfsad3peyg",
  "issns": [
    "2328-8957"
  ],
  "landing_url": "https://doi.org/10.1093/ofid/ofag630",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "AcademicSubjects/MED00290"
    ],
    [
      "heading",
      "Infectious Diseases in Special Populations"
    ],
    [
      "heading",
      "Major Article"
    ],
    [
      "openalex",
      "2725|COVID-19 Clinical Research Studies"
    ]
  ],
  "openalex": "W7225262109",
  "pdf_url": null,
  "pmcid": "PMC13732734",
  "pmid": "42985210",
  "published": "2026-11-04",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/387sfsad3peyg.ris",
  "sources": [
    {
      "first_seen": "2026-11-08T12:22:40Z",
      "native_id": "PMC13732734",
      "source": "pmc",
      "url": "https://doi.org/10.1093/ofid/ofag630"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2725|COVID-19 Clinical Research Studies",
      "subfield": "infectious-disease"
    }
  ],
  "title": "Early Remdesivir for Patients Who Are Immunocompromised and Hospitalized With COVID-19",
  "title_text": "Early Remdesivir for Patients Who Are Immunocompromised and Hospitalized With COVID-19",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T12:22:40Z",
  "url": "https://research.draconitic.com/paper/387sfsad3peyg",
  "venue": "Open Forum Infectious Diseases",
  "versions": []
}