Abstract: Original Investigation | Infectious Diseases Association of Remdesivir Treatment With Survival and Length of Hospital Stay Among US Veterans Hospitalized With COVID-19 Michael E. Ohl, MD, MSPH; Donald R. Miller, ScD; Brian C. Lund, PharmD; Takaaki Kobayashi, MD; Kelly Richardson Miell, PhD; Brice F. Beck, MA; Bruce Alexander, PharmD; Kristina Crothers, MD; Mary S. Vaughan Sarrazin, PhD Abstract Key Points IMPORTANCE Randomized clinical trials have yielded conflicting results about the effects of remdesivir therapy on survival and length of hospital stay among people with COVID-19. Question Is remdesivir treatment associated with improved survival or shortened hospitalizations among OBJECTIVE To examine associations between remdesivir treatment and survival and length of hospital stay among people hospitalized with COVID-19 in routine care settings. people with COVID-19 in routine care settings? Findings In this cohort study of 2344 DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the US veterans hospitalized with COVID-19, Veterans Health Administration (VHA) to identify adult patients in 123 VHA hospitals who had a first remdesivir therapy was not associated hospitalization with laboratory-confirmed COVID-19 from May 1 to October 8, 2020. Propensity with improved 30-day survival but was score matching of patients initiating remdesivir treatment to control patients who had not initiated associated with a significant increase in remdesivir treatment by the same hospital day was used to create the analytic cohort. median time to hospital discharge. Meaning The findings suggest that EXPOSURES Remdesivir treatment. routine use of remdesivir may be associated with increased use of MAIN OUTCOMES AND MEASURES Time to death within 30 days of remdesivir treatment initiation (or corresponding hospital day for matched control individuals) and time to hospital hospital beds but not with improvements in survival. discharge with time to death as a competing event. Associations between remdesivir treatment and these outcomes were assessed using Cox proportional hazards regression in the matched cohort. RESULTS The initial cohort included 5898 patients admitted to 123 hospitals, 2374 (40.3%) of whom received remdesivir treatment (2238 men [94.3%]; mean [SD] age, 67.8 [12.8] years) and 3524 (59.7%) of whom never received remdesivir treatment (3302 men [93.7%]; mean [SD] age, + Invited Commentary + Supplemental content Author affiliations and article information are listed at the end of this article. 67.0 [14.4] years). After propensity score matching, the analysis included 1172 remdesivir recipients and 1172 controls, for a final matched cohort of 2344 individuals. Remdesivir recipients and matched controls were similar with regard to age (mean [SD], 66.6 [14.2] years vs 67.5 [14.1] years), sex (1101 men [93.9%] vs 1101 men [93.9%]), dexamethasone use (559 [47.7%] vs 559 [47.7%]), admission to the intensive care unit (242 [20.7%] vs 234 [19.1%]), and mechanical ventilation use (69 [5.9%] vs 45 [3.8%]). Standardized differences were less than 10% for all measures. Remdesivir treatment was not associated with 30-day mortality (143 remdesivir recipients [12.2%] vs 124 controls [10.6%]; log rank P = .26; adjusted hazard ratio [HR], 1.06; 95% CI, 0.83-1.36). Results were similar for people receiving vs not receiving dexamethasone at remdesivir initiation (dexamethasone recipients: adjusted HR, 0.93; 95%..