Early Remdesivir for Patients Who Are Immunocompromised and Hospitalized With COVID-19
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.
Methods: 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”).
Results: 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.
Conclusions: 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.
Related
- Clinical factors associated with early multidomain symptomatic recovery in hospitalized patients with chronic lung disease and post-COVID conditions: a secondary analysis of a prospective controlled cohort
- Iron Dysregulation During Severe COVID-19: Longitudinal Evidence from Hospitalized Patients
- Clinical features of COVID-19 patients hospitalized at the Tashkent State Medical University and risk factors for intensive care unit admission: a cross-sectional study from Uzbekistan, Central Asia
- Immune parameters in hospitalized COVID-19 patients during SARS-CoV2 delta and omicron waves.
- Nutritional Status at Admission and Clinical Outcomes in Hospitalized Patients with COVID-19: Results from the MODIeCOSe in Italy Study
BibTeX
@article{hurwitz2026early,
title = {{Early Remdesivir for Patients Who Are Immunocompromised and Hospitalized With COVID-19}},
author = {Kathleen E Hurwitz and Mark Berry and EunYoung Lee and Kayla Hendrickson and Nuvan Rathnayaka and Valentina Shvachko and Mazin Abdelghany and Carrie M Nielson and M Alan Brookhart and Anand Chokkalingam and Joshua A Hill},
journal = {Open Forum Infectious Diseases},
year = {2026},
month = nov,
doi = {10.1093/ofid/ofag630},
url = {https://doi.org/10.1093/ofid/ofag630},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Early Remdesivir for Patients Who Are Immunocompromised and Hospitalized With COVID-19
AU - Kathleen E Hurwitz
AU - Mark Berry
AU - EunYoung Lee
AU - Kayla Hendrickson
AU - Nuvan Rathnayaka
AU - Valentina Shvachko
AU - Mazin Abdelghany
AU - Carrie M Nielson
AU - M Alan Brookhart
AU - Anand Chokkalingam
AU - Joshua A Hill
PY - 2026
DA - 2026/11/04
JO - Open Forum Infectious Diseases
DO - 10.1093/ofid/ofag630
UR - https://doi.org/10.1093/ofid/ofag630
AB - 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. Methods: 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”). Results: 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. Conclusions: 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.
SN - 2328-8957
ER -