Early Remdesivir May Reduce Mortality in Severe COVID Patients With Kidney or Liver Disease: Study

A new study published in the journal of Clinical Infectious Disease showed that adults hospitalized with severe COVID-19 who have underlying liver or renal illness may have a 25% lower chance of dying if they get remdesivir (RDV) therapy early.

Remdesivir, an antiviral medication that targets SARS-CoV-2 replication, has been used to enhance outcomes and slow the course of COVID-19 in hospitalized patients. However, early clinical studies frequently underestimated individuals with hepatic or renal comorbidities, raising questions about the efficacy of therapy in these high-risk groups. Drug metabolism, elimination, tolerability, and the actual clinical course of COVID-19 can all be impacted by renal and hepatic impairment. Therefore, evaluating the efficacy of remdesivir among hospitalized patients with these comorbidities is crucial for comprehending its practical advantages and guiding treatment choices, especially in patients who are more predisposed to severe illness and unfavorable outcomes. This study assessed the impact of early RDV commencement on 28-day all-cause in-hospital mortality in US patients with hepatic or renal comorbidities who were admitted for COVID-19.

Hospital chargemaster data and patient-level medical claims from the United States were utilized in this retrospective comparative efficacy analysis (2021-2025). A comparison was made between adults who got early RDV and those who did not. The usage of supplementary oxygen during the first two days of hospitalization was used to stratify the patients. Cox proportional hazards models were used to assess the risk of 28-day all-cause in-hospital death, which was the main outcome.

Following 1:1 propensity score matching, 5026 patients were included in the hepatic cohort (2513 per group) and 22,378 patients were included in the renal cohort (11,189 per group). In 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), early RDV was associated with a lower risk of 28-day all-cause in-hospital death.

Patients who received supplementary oxygen in both groups, as well as those in the hepatic cohort who did not receive supplemental oxygen, had a substantially decreased risk of death with early RDV commencement. Overall, patients with hepatic or renal impairment who were hospitalized for COVID-19 had better survival rates when RDV was started early. Early antiviral commencement may be crucial for high-risk persons with chronic organ failure, as evidenced by the benefit seen in infected patients who needed extra oxygen.

Reference:

Godwin, P., Shvachko, V., Oppelt, T., Wang, C.-Y., Lichtman, A., Berry, M., & Ahuja, N. (2026). Retrospective cohort study assessing remdesivir effectiveness in hospitalized COVID-19 patients with renal or hepatic comorbidities. Clinical Infectious Diseases, (ciag534). https://doi.org/10.1093/cid/ciag534