Effectiveness of Remdesivir for Hospitalized COVID-19 Patients Depending on the Severity of Respiratory Status: A Multicenter Retrospective Study in Japan

Abstract Remdesivir, approved for clinical use against COVID-19 worldwide, has varying effectiveness, depending on the respiratory failure status of patients. This retrospective observational study (the J- RECOVER) aimed to evaluate variations in remdesivir effectiveness by enrolling patients with COVID-19 from 64 institutions in Japan between January 1 and September 30, 2020. This study included patients aged ≥ 18 years who were administered with remdesivir within three days of admission. A total of 3,591 patients were eligible, and propensity score overlap weighting (OW) analysis was performed to compare in-hospital mortality as the primary outcome, depending on respiratory failure status, between the remdesivir-administered and control groups. The results exhibited the OW-adjusted odds ratio (OR) for mortality in overall cases (OR, 0.65; 95% confidence interval (CI), 0.36–1.19), mild cases without supplemental oxygen (OR, 0.11; 95% CI, 0.01–1.03), moderate cases requiring supplemental oxygen (OR, 0.82; 95% CI, 0.31–2.16), and severe cases requiring ventilation (OR, 0.78; 95% CI, 0.28 − 2.17). Remdesivir treatment may reduce the risk of in-hospital mortality among patients with mild respiratory distress. Additionally, the subgroup analysis suggests that remdesivir treatment may improve mortality in patients with an estimated glomerular filtration rate ≥ 60 mL/min per 1.73 m2 (P = 0.03).