Summary of COVID-19 remdesivir studies

70 patient remdesivir late treatment RCT: 76% higher mortality (p=0.47) and 112% higher ventilation (p=0.42).
Small RCT with 34 remdesivir patients and 36 controls finding no significant difference in clinical outcomes.
Mar 2021, Indian J. Anasthesia, https://www.ijaweb.org/article.asp?issn=0019-5049;year=2021;volume=65;issue=13;spage=41;epage=46;aulast=Mahajan, https://c19p.org/mahajan

2. Choi et al., Comparative effectiveness of combination therapy with nirmatrelvir–ritonavir and remdesivir versus monotherapy with remdesivir or nirmatrelvir–ritonavir in patients hospitalised with COVID-19: a target trial emulation study

13,964 patient remdesivir early treatment study: 267% higher mortality (p=0.07), 600% higher ICU admission (p<0.0001), 686% higher need for oxygen therapy (p<0.0001), and 182% worse results (p<0.0001).
Target trial emulation study of 18,196 hospitalized COVID-19 patients in Hong Kong showing significantly higher ICU admission and AKI with remdesivir + paxlovid compared with paxlovid alone, and lower mortality and ventilatory support with remdesivir + paxlovid compared with remdesivir alone. Patients were treated within 5 days of diagnosis, however the time from onset is not known.
Jul 2024, The Lancet Infectious Diseases, https://www.sciencedirect.com/science/article/pii/S1473309924003530, https://c19p.org/choi7

3. Ong et al., A cohort study of COVID-19 infection in pediatric oncology patients plus the utility and safety of remdesivir treatment

18 patient remdesivir early treatment study: 75% slower recovery (p=0.6), 56% longer hospitalization (p=0.31), and 61% slower viral clearance (p=0.14).
Retrospective 18 immunocompromised pediatric COVID-19 patients in Singapore, showing slower viral clearance with remdesivir, without statistical significance.
Jan 2023, Acta Oncologica, https://www.tandfonline.com/doi/full/10.1080/0284186X.2023.2169079, https://c19p.org/ong3

4. Cacho et al., Use of remdesivir in kidney transplant recipients with SARS-CoV-2 Omicron infection

98 patient remdesivir late treatment study: 44% higher severe cases (p=0.58), 73% more moderate/severe cases (p=0.09), and 92% lower hospital discharge (p=0.35).
Retrospective 98 kidney transplant recipients with SARS-CoV-2 Omicron infection in Spain, showing no significant difference in mortality with remdesivir treatment. Earlier administration was associated with improved results, although this analysis is subject to survivorship/selection bias.
Oct 2022, Kidney Int., https://www.sciencedirect.com/science/article/pii/S0085253822006135, https://c19p.org/cacho

5. Chang et al., The association between COVID-19 vaccination and confirmed patients with hospitalization in Omicron era: A retrospective study

209 patient remdesivir late treatment study: 185% higher mortality (p=0.04).
Retrospective 209 hospitalized COVID-19 patients in Taiwan showing higher mortality with a 5-day course of remdesivir compared to other antivirals or no antiviral treatment in multivariable analysis. Adjustments include qSOFA and CCI, with the adjusted result decreasing risk by 3x, however adjustment may not fully account for confounding by severity.
Dec 2023, Medicine, https://journals.lww.com/md-journal/fulltext/2023/12290/the_association_between_covid_19_vaccination_and.45.aspx, https://c19p.org/chang8

6. Ho et al., A Retrospective Cohort Study Assessing the Impact of Statin Therapy on Hospital Length of Stay and Inpatient Mortality in COVID-19 Patients

26,445 patient remdesivir late treatment study: 62% higher mortality (p<0.0001).
Retrospective 26,445 hospitalized COVID-19 patients in the USA, showing higher mortality with remdesivir.
Oct 2023, HCA Healthcare J. Medicine, https://scholarlycommons.hcahealthcare.com/hcahealthcarejournal/vol4/iss5/5, https://c19p.org/ho3

7. Chew et al., Clinical Predictors for Abnormal ALT in Patients Infected with COVID-19—A Retrospective Single Centre Study

163 patient remdesivir early treatment study: 68% higher progression (p=0.4).
Retrospective 163 COVID-19 patients in Singapore, showing increased risk of liver injury (abnormal ALT) with acetaminophen in a dose-dependent manner, and with remdesivir, without statistical significance in both cases.
Mar 2023, Pathogens, https://www.mdpi.com/2076-0817/12/3/473, https://c19p.org/chew2s

8. Kim et al., Clinical Outcome and Prognosis of a Nosocomial Outbreak of COVID-19

167 patient remdesivir late treatment study: 1612% higher mortality (p=0.22).
Retrospective 167 nosocomial COVID-19 patients in South Korea, showing higher mortality with remdesivir treatment, without statistical significance.
Mar 2023, J. Clinical Medicine, https://www.mdpi.com/2077-0383/12/6/2279, https://c19p.org/kim10

9. Bowen et al., Reduction in risk of death among patients admitted with COVID-19 between first and second epidemic waves in New York City

4,631 patient remdesivir late treatment study: 57% higher mortality (p=0.0001).
Retrospective 4,631 hospitalized patients in New York, showing higher mortality with remdesivir, and lower mortality with HCQ. Authors suggest that increased mortality during the first epidemic wave was partly due to strain on hospital resources.
Aug 2022, Open Forum Infectious Diseases, https://academic.oup.com/ofid/advance-article/doi/10.1093/ofid/ofac436/6675651, https://c19p.org/bowens

10. Killingley et al., Safety, tolerability and viral kinetics during SARS-CoV-2 human challenge in young adults

18 patient remdesivir early treatment study: 60% higher progression (p=0.43).
SARS-CoV-2 challenge study in 36 low-risk young adults. Infected participants had high viral loads peaking around 5 days post-exposure, mild-to-moderate upper respiratory symptoms, and anosmia, but no severe disease. Remdesivir had no significant effect on viral kinetics or symptoms. There was a 1-2 day delay before significant viral spread. A majority of patients reported symptoms prior to significant viral spread, supporting the use of early treatment targeted at the upper respiratory tract as a promising approach to limit progression of SARS-CoV-2.
Mar 2022, Nature Medicine, https://www.nature.com/articles/s41591-022-01780-9, https://c19p.org/killingley

11. Schmidt et al., Association Between Androgen Deprivation Therapy and Mortality Among Patients With Prostate Cancer and COVID-19

477 patient remdesivir late treatment PSM study: 509% higher severe cases (p<0.0001).
Retrospective 1,106 prostate cancer patients, showing higher mortality with remdesivir treatment.
Nov 2021, JAMA Network Open, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2786026, https://c19p.org/schmidts

12. Wang et al., Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial

236 patient remdesivir late treatment RCT: 9% higher mortality (p=1).
Small RCT with 237 hospitalized patients in China with severe COVID-19, not showing statistically significant benefits. 158 treatment patients and 79 control patients. While too small for significance, the subgroup treated within 10 days showed reduced mortality RR 0.76, p = 0.58, and reduced median time to clinical improvement of 18 days vs. 23 days, hazard ratio 1.52 [0.95-2.43].
Apr 2020, Lancet, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31022-9/fulltext, https://c19p.org/wangr

13. Punzalan et al., Utility of laboratory and immune biomarkers in predicting disease progression and mortality among patients with moderate to severe COVID-19 disease at a Philippine tertiary hospital

400 patient remdesivir late treatment study: 42% higher mortality (p=0.12) and 59% higher progression (p=0.001).
Prospective study of 400 hospitalized patients in the Philippines, showing higher progression with remdesivir in unadjusted results, without statistical significance.
Feb 2023, Frontiers in Immunology, https://www.frontiersin.org/articles/10.3389/fimmu.2023.1123497/full, https://c19p.org/punzalan

14. Ohl et al., Association of Remdesivir Treatment With Survival and Length of Hospital Stay Among US Veterans Hospitalized With COVID-19

2,344 patient remdesivir late treatment PSM study: 6% higher mortality (p=0.66) and 100% longer hospitalization (p=0.001).
Retrospective 5,898 hospitalized patients in the USA, 2,374 receiving remdesivir treatment, showing no significant difference in mortality, and a longer time to hospital discharge with treatment.
Jul 2021, JAMA Network Open, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781959, https://c19p.org/ohl

15. Ullah et al., Efficacy of Remdesivir in Covid-19 Patients; Multicenter Study in Lahore

60 patient remdesivir late treatment study: 100% higher mortality (p=0.33) and 250% higher ventilation (p=0.15).
Small late stage (hospitalized, <12 days symptoms) remdesivir study showing non-statistically significant higher mortality with treatment. No adjustments were made for differences in the groups. Remdesivir mean age was 49 vs. control 57. Baseline oxygen requirement was 13.4 liters treatment vs. 10.8 control. Potential confounding by indication.
Nov 2020, Int. J. Sciences, https://www.ijsciences.com/pub/article/2417, https://c19p.org/ullah

16. Alsaraj et al., Consequence of Antivirals Versus Standard Care on Clinical Situation in Patients With COVID-19

105 patient remdesivir late treatment RCT: 83% higher mortality (p=0.26).
RCT 156 COVID-19 patients showing higher mortality with favipiravir and remdesivir overall. Favipiravir and remdesivir were more effective when started earlier, however note that Table 10 compares earlier favipiravir/remdesivir+standard care with standard care at any time, which will exaggerate the benefits/harms of earlier/later treatment. The confidence intervals for the Cox results are unusually narrow suggesting a possible error in calculation.
Jan 2024, Infectious Diseases in Clinical Practice, https://journals.lww.com/10.1097/IPC.0000000000001336, https://c19p.org/alsaraj

17. Milan et al., Factors Associated with Adverse Outcomes among SARS-CoV-2 Positive Children in a Tertiary Government COVID-19 Referral Hospital in the Philippines

180 patient remdesivir late treatment study: 122% higher ventilation (p=0.15) and 419% higher ICU admission (p<0.0001).
Retrospective 180 hospitalized pediatric COVID-19 patients in the Philippines showing lower mortality with vitamin D and zinc, and higher mortality with remdesivir, all without statistical significance. Remdesivir was given to few patients and authors do not provide information on the timing of treatment - confounding by indication may be significant.
Apr 2024, Acta Medica Philippina, https://actamedicaphilippina.upm.edu.ph/index.php/acta/article/view/8392, https://c19p.org/milans

18. Amirizadeh et al., The effect of remdesivir on mortality and the outcome of patients with COVID‐19 in intensive care unit: A case–control study

70 patient remdesivir ICU study: 3% higher mortality (p=1), 52% longer ventilation (p=0.17), 27% longer ICU admission (p=0.23), and 24% longer hospitalization (p=0.22).
Retrospective 70 COVID-19 ICU patients, 35 receiving remdesivir plus standard treatment and 35 receiving standard treatment only. No significant differences were found for mortality, hospitalization time, ICU time, or ventilation time.
Oct 2023, Health Science Reports, https://onlinelibrary.wiley.com/doi/10.1002/hsr2.1676, https://c19p.org/amirizadeh

19. Siami et al., Clinical outcomes and considerations in outpatient with COVID‐19 receiving remdesivir therapy

514 patient remdesivir early treatment study: 70% higher hospitalization (p=0.2).
Retrospective 514 COVID-19 outpatients showing no significant benefit with remdesivir therapy.
Jul 2024, Health Science Reports, https://onlinelibrary.wiley.com/doi/10.1002/hsr2.2252, https://c19p.org/siami

20. Seah et al., Remdesivir therapy for severe pediatric COVID‐19 in Singapore: A single‐center retrospective observational cohort study

15 patient remdesivir early treatment study: 129% worse recovery (p=0.57).
Retrospective 15 pediatric patients hospitalized for severe COVID-19 requiring oxygen and high dependency/intensive care unit (HD/ICU) admission in Singapore, showing no improvement in deescalation from HD/ICU care with remdesivir, however the remdesivir group had higher disease severity.
Dec 2023, Health Science Reports, https://onlinelibrary.wiley.com/doi/10.1002/hsr2.1698, https://c19p.org/seah

21. Kurniyanto et al., Factors Associated with Death and ICU Referral among COVID-19 Patients Hospitalized in the Secondary Referral Academic Hospital in East Jakarta, Indonesia

477 patient remdesivir late treatment study: 460% higher mortality (p=0.0009).
Retrospective 477 hospitalized patients in Indonesia, showing higher mortality with remdesivir in unadjusted results.
Feb 2022, J. Clinical Virology Plus, https://www.sciencedirect.com/science/article/pii/S2667038022000084, https://c19p.org/kurniyantos

22. Elavarasi et al., Clinical features, demography, and predictors of outcomes of SARS-CoV-2 infection at a tertiary care hospital in India: A cohort study

1,755 patient remdesivir late treatment study: 137% higher mortality (p<0.0001).
Retrospective 2017 hospitalized patients in India, showing higher mortality with remdesivir in unadjusted results, however no group details are provided and this result is subject to confounding by indication, with authors suggesting treatment was more likely for more severe patients.
Aug 2021, Lung India, https://journals.lww.com/lungindia/Fulltext/2022/01000/Clinical_features,_demography,_and_predictors_of.5.aspx, https://c19p.org/elavarasis

23. Mulhem et al., 3219 hospitalised patients with COVID-19 in Southeast Michigan: a retrospective case cohort study

3,219 patient remdesivir late treatment study: 86% higher mortality (p=0.54).
Retrospective database analysis of 3,219 hospitalized patients in the USA. Very different results in the time period analysis (Table S2), and results significantly different to other studies for the same medications (e.g., heparin OR 3.06 [2.44-3.83]) suggest significant confounding by indication and confounding by time.
Apr 2021, BMJ Open, https://bmjopen.bmj.com/content/11/4/e042042.info, https://c19p.org/mulhems

24. Lewandowski et al., Insulin and Metformin Administration: Unravelling the Multifaceted Association with Mortality across Various Clinical Settings Considering Type 2 Diabetes Mellitus and COVID-19

430 patient remdesivir late treatment study: 21% higher mortality (p=0.55).
Retrospective 430 hospitalized COVID-19 patients with type 2 diabetes in Poland showing lower mortality with metformin and higher mortality with remdesivir, convalescent plasma, and aspirin in univariable analysis. These results were not statistically significant except for aspirin, and no baseline information per treatment is provided to assess confounding.
Mar 2024, Biomedicines, https://www.mdpi.com/2227-9059/12/3/605, https://c19p.org/lewandowski2

25. Muntean et al., Effects of COVID-19 on the Liver and Mortality in Patients with SARS-CoV-2 Pneumonia Caused by Delta and Non-Delta Variants: An Analysis in a Single Centre

551 patient remdesivir late treatment study: 45% higher mortality (p=0.03).
Retrospective 551 severe/critical COVID-19 patients showing higher mortality and higher risk of drug induced liver injury with remdesivir. Authors appear to have reversed the OR for remdesivir - use was more common in non-survivors (61% vs. 50%). Authors report 116 patients treated with HCQ but provide no results for HCQ.
Dec 2023, Pharmaceuticals, https://www.mdpi.com/1424-8247/17/1/3, https://c19p.org/muntean

26. Burhan et al., Characteristics and outcomes of patients with severe COVID-19 in Indonesia: Lessons from the first wave

559 patient remdesivir ICU study: 15% higher mortality (p=0.23).
Retrospective 559 COVID-19 ICU patients in Indonesia, showing higher mortality with remdesivir in unadjusted results, without statistical significance. Note that confounding by indication should be less significant for ICU studies compared to studies of all hospitalized patients, because all patients are in critical condition.
Sep 2023, PLOS ONE, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0290964, https://c19p.org/burhans

27. Aweimer et al., Mortality rates of severe COVID-19-related respiratory failure with and without extracorporeal membrane oxygenation in the Middle Ruhr Region of Germany

149 patient remdesivir ICU study: 13% higher mortality (p=0.33).
Retrospective 149 patients under invasive mechanical ventilation in Germany showing no significant difference in mortality with remdesivir in unadjusted results.
Mar 2023, Scientific Reports, https://www.nature.com/articles/s41598-023-31944-7, https://c19p.org/aweimers

28. Mitsushima et al., Risk of Underlying Diseases and Effectiveness of Drugs on COVID-19 Inpatients Assessed Using Medical Claims in Japan: Retrospective Observational Study

remdesivir late treatment study: 44% higher mortality (p=0.01).
Retrospective 18,566 hospitalized patients in Japan, showing higher mortality with remdesivir treatment.
Feb 2023, Int. J. General Medicine, https://www.dovepress.com/risk-of-underlying-diseases-and-effectiveness-of-drugs-on-covid-19-inp-peer-reviewed-fulltext-article-IJGM, https://c19p.org/mitsushima

29. Yeramaneni et al., Famotidine Use Is Not Associated With 30-day Mortality: A Coarsened Exact Match Study in 7158 Hospitalized Patients With Coronavirus Disease 2019 From a Large Healthcare System

7,158 patient remdesivir late treatment study: 24% higher mortality (p=0.87).
Retrospective 7,158 hospitalized COVID-19 patients in the USA analyzing famotidine treatment, showing no significant difference in mortality with associated remdesivir treatment.
Feb 2021, Gastroenterology, https://www.gastrojournal.org/article/S0016-5085(20)35249-5/fulltext, https://c19p.org/yeramanenis

30. Kawther et al., Antiviral drug treatment profiles and clinical outcomes of COVID-19 patients at public hospitals in Erbil city

451 patient remdesivir late treatment study: 9% higher mortality (p=0.86).
Retrospective 451 hospitalized COVID-19 patients in Iraq showing no significant difference in mortality with remdesivir treatment.
Sep 2024, Advanced medical journal, https://amj.khcms.edu.krd/index.php/main/article/view/473, https://c19p.org/kawther

31. Drouin et al., Clinical and laboratory characteristics of patients hospitalized with severe COVID-19 in New Orleans, August 2020 to September 2021

456 patient remdesivir late treatment study: 46% higher severe cases (p<0.0001).
Retrospective 456 hospitalized patients in the USA showing an association between remdesivir treatment and increased COVID-19 severity in multivariable analysis, for remdesivir treatment within 7 days and when administered before meeting the severe case definition. Authors suggest this is due to remdesivir being preferentially used for more severe cases, citing Bhimraj et al., however that paper is from April 2020 before widespread use of remdesivir. During the period of the current study remdesivir was more widely recommended. However, there could still be significant residual confounding after adjustments.
Mar 2024, Scientific Reports, https://www.nature.com/articles/s41598-024-57306-5, https://c19p.org/drouin

32. Liao et al., Clinical characteristics and outcomes among critically ill patients with cancer and COVID-19-related acute respiratory failure

65 patient remdesivir late treatment study: 25% higher mortality (p=0.67).
Retrospective study of 215 critically ill COVID-19 patients with respiratory failure showing higher mortality for cancer patients. Remdesivir was used more for non-survivors, without statistical significance. Most patients received remdesivir, suggesting standard use for critically ill patients at the time, however it is not clear why some patients did not receive treatment, and baseline details per group are not provided.
Jan 2024, BMC Pulmonary Medicine, https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-024-02850-z, https://c19p.org/liao3

33. Nadeem et al., Effects of Different Anticoagulation Doses on Moderate-to-Severe COVID-19 Pneumonia With Hypoxemia

132 patient remdesivir late treatment study: 12% higher mortality (p=1).
Retrospective 132 hospitalized COVID-19 patients in the USA, showing no significant difference in mortality with remdesivir in unadjusted results.
Aug 2023, Cureus, https://www.cureus.com/articles/165816-effects-of-different-anticoagulation-doses-on-moderate-to-severe-covid-19-pneumonia-with-hypoxemia, https://c19p.org/nadeem

34. Oku et al., Risk factors for hospitalization or mortality for COVID-19 in patients with rheumatic diseases: Results of a nation-wide JCR COVID-19 registry in Japan

218 patient remdesivir late treatment study: 40% higher mortality (p=0.59).
Retrospective 220 COVID-19 patients with rheumatic disease in Japan, showing no significant difference in mortality with remdesivir treatment.
Sep 2022, Modern Rheumatology, https://academic.oup.com/mr/advance-article/doi/10.1093/mr/roac104/6692611, https://c19p.org/okus

35. Malundo et al., Predictors of Mortality among inpatients with COVID-19 Infection in a Tertiary Referral Center in the Philippines

1,215 patient remdesivir late treatment study: 17% higher mortality (p=0.45).
Retrospective 1,215 hospitalized patients in the Phillipines, showing no significant difference in outcomes with remdesivir or HCQ use in unadjusted results subject to confounding by indication.
Jul 2022, IJID Regions, https://www.sciencedirect.com/science/article/pii/S2772707622000935, https://c19p.org/malundos

36. Elhadi et al., Epidemiology, outcomes, and utilization of intensive care unit resources for critically ill COVID-19 patients in Libya: A prospective multi-center cohort study

465 patient remdesivir ICU study: 11% higher mortality (p=0.65).
Prospective study of 465 COVID-19 ICU patients in Libya showing no significant differences with treatment.
Apr 2021, PLOS ONE, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251085, https://c19p.org/elhadis

37. Sise et al., Efficacy and Safety of Remdesivir in People With Impaired Kidney Function Hospitalized for Coronavirus Disease 2019 Pneumonia: A Randomized Clinical Trial

243 patient remdesivir late treatment RCT: no change in mortality (p=1), 18% lower combined mortality/intubation (p=0.61), and 16% improvement (p=0.5).
RCT 243 hospitalized COVID-19 patients with acute kidney injury, chronic kidney disease, or kidney failure showing no significant difference in all-cause mortality or invasive mechanical ventilation with remdesivir. The lower mortality at day 29 (without statistical significance) disappeared at day 60, consistent with remdesivir studies overall.
Jun 2024, Clinical Infectious Diseases, https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae333/7697980, https://c19p.org/sise

38. Anzalone et al., Associations between COVID‐19 therapies and outcomes in rural and urban America: A multisite, temporal analysis from the Alpha to Omicron SARS‐CoV‐2 variants

remdesivir late treatment PSM study: 33% higher mortality (p<0.0001) and 8% lower ventilation (p<0.0001).
Retrospective 3,018,646 COVID-19 patients in the US showing higher rates of hospitalization, inpatient death, acute kidney injury, major adverse cardiovascular events, and need for mechanical ventilation among rural patients compared to urban patients. The increased risk for rural patients persisted across pre-delta, delta, and omicron variant periods and after adjustments.
Jul 2024, The J. Rural Health, https://onlinelibrary.wiley.com/doi/10.1111/jrh.12857, https://c19p.org/anzalone

39. Pourhoseingholi et al., Case Characteristics, Clinical Data, And Outcomes of Hospitalized COVID-19 Patients In Qom Province, Iran: A Prospective Cohort Study

2,468 patient remdesivir late treatment study: 2% higher mortality (p=0.92).
Prospective study of 2,468 hospitalized COVID-19 patients in Iran, showing no significant difference with remdesivir treatment. IR.MUQ.REC.1399.013.
May 2021, Research Square, https://www.researchsquare.com/article/rs-365321/v2, https://c19p.org/pourhoseingholis

40. Tsuzuki et al., Efficacy of remdesivir in hospitalized nonsevere COVID-19 patients in Japan: A large observational study using the COVID-19 Registry Japan

12,487 patient remdesivir late treatment study: 4% higher mortality (p=0.21), 2% lower ventilation (p=0.68), and 15% lower progression (p=0.68).
Retrospective database analysis of 12,487 hospitalized patients in Japan, showing lower risk of oxygen requirement, but no significant difference in mortality or ventilation/ECMO.
Mar 2021, Int. J. Infectious Diseases, https://www.sciencedirect.com/science/article/pii/S1201971222001187, https://c19p.org/tsuzuki

41. Shamsi et al., Survival and Mortality in Hospitalized Children with COVID-19: A Referral Center Experience in Yazd, Iran

183 patient remdesivir late treatment study: 23% higher mortality (p=0.63).
Retrospective 183 hospitalized pediatric COVID-19 patients in Iran, showing no significant difference in mortality with in unadjusted results.
Jul 2023, Canadian J. Infectious Diseases and Medical Microbiology, https://www.hindawi.com/journals/cjidmm/2023/5205188/, https://c19p.org/shamsis

42. Barrat-Due et al., Evaluation of the Effects of Remdesivir and Hydroxychloroquine on Viral Clearance in COVID-19

118 patient remdesivir late treatment RCT: 47% worse recovery (p=0.01).
Small RCT in Norway showing no significant differences with remdesivir treatment. Add-on trial to WHO Solidarity. Longer term recovery results are from [Patrick-Brown].
Jul 2021, Annals of Internal Medicine, https://www.acpjournals.org/doi/10.7326/M21-0653, https://c19p.org/barratdues

43. Sokolski et al., Antiplatelet therapy prior to COVID-19 infection impacts on patients mortality: a propensity score-matched cohort study

548 patient remdesivir late treatment study: no change in mortality (p=1).
Retrospective 2,170 hospitalized COVID-19 patients showing no difference in mortality with remdesivir in unadjusted results.
Feb 2024, Scientific Reports, https://www.nature.com/articles/s41598-024-55407-9, https://c19p.org/sokolskis

44. Arfijanto et al., Duration of SARS-CoV-2 RNA Shedding Is Significantly Influenced by Disease Severity, Bilateral Pulmonary Infiltrates, Antibiotic Treatment, and Diabetic Status: Consideration for Isolation Period

162 patient remdesivir late treatment study: 1% improved viral clearance (p=1).
Retrospective 162 hospitalized COVID-19 patients in Indonesia, showing no significant difference in delayed viral clearance with remdesivir treatment in unadjusted results.
May 2023, Pathophysiology, https://www.mdpi.com/1873-149X/30/2/16, https://c19p.org/arfijantos

45. Elec et al., COVID-19 and Kidney Transplantation: The impact of remdesivir on renal function and outcome - a retrospective cohort study

165 patient remdesivir late treatment study: 19% lower mortality (p=0.66), 11% lower ventilation (p=0.73), and 72% higher ICU admission (p=0.01).
Retrospective 165 hospitalized COVID-19+ kidney transplant patients, 38 treated with remdesivir, showing no significant difference in mortality, higher ICU admission, and lower ICU mortality. Subject to confounding by time with significant changes to SOC and treatment propensity during the study period.
Mar 2022, Int. J. Infectious Diseases, https://www.sciencedirect.com/science/article/pii/S1201971222001515, https://c19p.org/elec

46. Mustafa et al., Pattern of medication utilization in hospitalized patients with COVID-19 in three District Headquarters Hospitals in the Punjab province of Pakistan

444 patient remdesivir late treatment study: 33% lower mortality (p=0.21).
Retrospective 444 hospitalized patients in Pakistan, showing lower mortality with remdesivir treatment in unadjusted results, not reaching statistical significance.
Dec 2021, Exploratory Research in Clinical and Social Pharmacy, https://www.sciencedirect.com/science/article/pii/S2667276621001013, https://c19p.org/mustafas

47. Kuno et al., The association of remdesivir and in-hospital outcomes for COVID-19 patients treated with steroids

1,998 patient remdesivir late treatment PSM study: 1% lower mortality (p=0.96), no change in ventilation (p=1), and 17% higher ICU admission (p=0.05).
PSM retrospective 3,372 hospitalized patients in the USA treated with steroids, showing no significant difference in mortality with remdesivir, but a lower risk of acute kidney injury.
Aug 2021, J. Antimicrobial Chemotherapy, https://academic.oup.com/jac/advance-article/doi/10.1093/jac/dkab256/6345860, https://c19p.org/kuno

48. Hagman et al., Effects of remdesivir on SARS-CoV-2 viral dynamics and mortality in viraemic patients hospitalized for COVID-19

318 patient remdesivir late treatment study: no change in mortality (p=0.97), 40% higher progression (p=0.31), and 29% improved viral clearance (p=0.11).
Retrospective 318 hospitalized COVID-19 patients in Sweden, showing improvements in viral clearance but no improvement for mortality with remdesivir treatment.
Sep 2023, J. Antimicrobial Chemotherapy, https://academic.oup.com/jac/advance-article/doi/10.1093/jac/dkad295/7283037, https://c19p.org/hagman

49. Jamir et al., Determinants of Outcome Among Critically Ill Police Personnel With COVID-19: A Retrospective Observational Study From Andhra Pradesh, India

266 patient remdesivir ICU study: 8% lower mortality (p=0.77).
Retrospective 266 COVID-19 ICU patients in India, showing significantly lower mortality with PVP-I oral gargling and topical nasal use, and non-statistically significant higher mortality with ivermectin and lower mortality with remdesivir.
Dec 2021, Cureus, https://www.cureus.com/articles/73667-determinants-of-outcome-among-critically-ill-police-personnel-with-covid-19-a-retrospective-observational-study-from-andhra-pradesh-india, https://c19p.org/jamirs

50. Haji Aghajani et al., Decreased In-Hospital Mortality Associated with Aspirin Administration in Hospitalized Patients Due to Severe COVID-19

991 patient remdesivir late treatment study: 19% lower mortality (p=0.49).
Retrospective 991 hospitalized patients in Iran focusing on aspirin use but also showing results for HCQ, remdesivir, and favipiravir.
Apr 2021, J. Medical Virology, https://europepmc.org/article/med/33913549, https://c19p.org/hajiaghajanis

51. Salehi et al., Risk factors of death in mechanically ventilated COVID-19 patients: a retrospective multi-center study

125 patient remdesivir ICU study: 37% lower mortality (p=0.01).
Retrospective 125 mechanically ventilated ICU patients in Iran, showing lower mortality with remdesivir treatment in unadjusted results.
Mar 2022, Research Square, https://www.researchsquare.com/article/rs-1362678/v1, https://c19p.org/salehi

52. Behboodikhah et al., Evaluation of the Costs and Outcomes of COVID-19 Therapeutic Regimens in Hospitalized Patients in Shiraz

2,174 patient remdesivir late treatment study: 38% lower mortality (p=0.21).
Retrospective 2,174 hospitalized patients showing no significant differences with remdesivir treatment.
Sep 2022, Iranian J. Science and Technology, Transactions A: Science, https://link.springer.com/10.1007/s40995-022-01351-0, https://c19p.org/behboodikhahs

53. Zangeneh et al., Survival analysis based on body mass index in patients with Covid-19 admitted to the intensive care unit of Amir Al-Momenin Hospital in Arak – 2021

remdesivir ICU study: 32% lower mortality (p=0.06).
Retrospective 193 ICU patients in Iran, showing lower mortality with remdesivir treatment, not reaching statistical significance.
May 2022, Obesity Medicine, https://www.sciencedirect.com/science/article/pii/S245184762200032Xhttps://www.sciencedirect.com/science/article/pii/S245184762200032X/pdf, https://c19p.org/zangenehs

54. Goldberg et al., A real-life setting evaluation of the effect of remdesivir on viral load in COVID-19 patients admitted to a large tertiary center in Israel

142 patient remdesivir late treatment study: 9% shorter hospitalization (p=0.77) and no change in viral clearance (p=0.98).
Retrospective 29 remdesivir patients and 113 controls, not finding a significant difference in nasopharyngeal viral load or hospitalization time. Hospitalization time was lower with treatment, with a larger reduction for non-intubated patients, although not statistically significant in both cases.
Mar 2021, Clinical Microbiology and Infection, https://www.sciencedirect.com/science/article/pii/S1198743X21001130, https://c19p.org/goldberg

55. Arch et al., Evaluation of the effectiveness of remdesivir in treating severe COVID-19 using data from the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, national cohort study

6,230 patient remdesivir late treatment PSM study: 20% lower mortality (p=0.03) and 68% higher ventilation (p=0.003).
Prospective PSM analysis of remdesivir use in the UK showing statistically significantly lower mortality at 28 days. For unspecified reasons, the study prioritized short-term outcomes. Mortality at 14 days was also lower but not statistically significant. Confounding by indication is likely and may only be partially addressed by the variables included in the PSM.
Jun 2021, medRxiv, https://www.medrxiv.org/content/10.1101/2021.06.18.21259072v1, https://c19p.org/arch

56. Hartantri et al., Clinical and treatment factors associated with the mortality of COVID-19 patients admitted to a referral hospital in Indonesia

remdesivir late treatment study: 11% lower mortality (p=0.84).
Retrospective 689 hospitalized patients in Indonesia, showing no significant difference in mortality with remdesivir treatment.
Feb 2023, The Lancet Regional Health - Southeast Asia, https://www.sciencedirect.com/science/article/pii/S2772368223000276, https://c19p.org/hartantris

57. Kneidinger et al., Outcome of lung transplant recipients infected with SARS-CoV-2/Omicron/B.1.1.529: a Nationwide German study

218 patient remdesivir early treatment study: 20% lower severe cases (p=0.71).
Retrospective 218 COVID+ lung transplant patients in Germany, showing no significant difference in severe cases with early remdesivir use.
Sep 2022, Infection, https://link.springer.com/10.1007/s15010-022-01914-8, https://c19p.org/kneidingers

58. Bavaro et al., Efficacy of Remdesivir and Neutralizing Monoclonal Antibodies in Monotherapy or Combination Therapy in Reducing the Risk of Disease Progression in Elderly or Immunocompromised Hosts Hospitalized for COVID-19: A Single Center Retrospective Study

331 patient remdesivir late treatment study: 7% lower severe cases (p=0.001).
Retrospective 331 hospitalized COVID-19 patients in Italy, showing lower progression with remdesivir. Combination therapy with mAbs was more effective, and improved results were seen for immunocompromised patients.
May 2023, Viruses, https://www.mdpi.com/1999-4915/15/5/1199, https://c19p.org/bavaro

59. SOLIDARITY Trial Consortium et al., Repurposed antiviral drugs for COVID-19; interim WHO SOLIDARITY trial results

5,451 patient remdesivir late treatment RCT: 5% lower mortality (p=0.53).
WHO SOLIDARITY open-label RCT with 2,750 very late stage (76% on oxygen/ventilation) remdesivir patients, mortality relative risk RR 0.95 [0.81-1.11], p=0.50. Non-ventilated patients show a greater benefit, RR 0.86 [0.72-1.04], p = 0.13.
Oct 2020, SOLIDARITY Trial Consortium, NEJM, https://www.nejm.org/doi/full/10.1056/NEJMoa2023184, https://c19p.org/solidaritys

60. Madan et al., Remdesivir for the treatment of COVID-19 disease: A retrospective comparative study of patients treated with and without Remdesivir

658 patient remdesivir late treatment study: 44% lower mortality (p=0.03).
Retrospective 1,262 hospitalized patients, 398 treated with remdesivir, showing unadjusted lower mortality with treatment, and a treatment delay-response relationship. Results for early treatment are listed separately [Madan].
Jul 2021, medRxiv, https://www.medrxiv.org/content/10.1101/2021.07.15.21260600v1, https://c19p.org/madan

61. Ader et al., Remdesivir plus standard of care versus standard of care alone for the treatment of patients admitted to hospital with COVID-19 (DisCoVeRy): a phase 3, randomised, controlled, open-label trial

832 patient remdesivir late treatment RCT: 6% lower mortality (p=0.77) and 10% improved 7-point scale results (p=0.39).
RCT 857 hospitalized patients, showing no significant differences with remdesivir treatment. EudraCT2020-000936-23.
Sep 2021, Lancet Infectious Diseases, https://www.sciencedirect.com/science/article/pii/S1473309921004850, https://c19p.org/ader

62. El-Solh et al., Clinical Course and Outcome of COVID-19 Acute Respiratory Distress Syndrome: Data From a National Repository

643 patient remdesivir late treatment study: 29% lower mortality (p=0.03).
Retrospective 7,816 Veterans Affairs hospitalized patients showing lower mortality with remdesivir.
Oct 2020, J. Intensive Care Medicine, http://journals.sagepub.com/doi/10.1177/0885066621994476PERIOD:1/1/2020-8/1/2020;GROUP:elsolh, https://c19p.org/elsolh

63. Madan et al., Remdesivir for the treatment of COVID-19 disease: A retrospective comparative study of patients treated with and without Remdesivir

372 patient remdesivir early treatment study: 66% lower mortality (p=0.04).
Retrospective 1,262 hospitalized patients, 398 treated with remdesivir, showing unadjusted lower mortality with treatment, and a treatment delay-response relationship. Results for late treatment are listed separately [Madan].
Jul 2021, medRxiv, https://www.medrxiv.org/content/10.1101/2021.07.15.21260600v1, https://c19p.org/madan2

64. Garibaldi et al., Effectiveness of remdesivir with and without dexamethasone in hospitalized patients with COVID-19

606 patient remdesivir late treatment study: 20% lower mortality (p=0.44) and 35% greater improvement (p<0.0001).
Retrospective 303 remdesivir patients and 303 matched controls showing significantly faster clinical improvement, and lower (but not statistically significant) mortality.
Nov 2020, medRxiv, https://www.medrxiv.org/content/10.1101/2020.11.19.20234153v1, https://c19p.org/garibaldi

65. Mozaffari et al., Remdesivir treatment in hospitalized patients with COVID-19: a comparative analysis of in-hospital all-cause mortality in a large multi-center observational cohort

57,710 patient remdesivir late treatment study: 12% lower mortality (p=0.003).
Retrospective 28,855 remdesivir patients with PSM matched controls, showing lower mortality with treatment.
Sep 2021, Clinical Infectious Diseases, https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab875/6378778, https://c19p.org/mozaffari

66. Pasquini et al., Effectiveness of remdesivir in patients with COVID-19 under mechanical ventilation in an Italian ICU

51 patient remdesivir ICU study: 16% lower mortality (p=0.03).
Retrospective 51 ICU patients under mechanical ventilation, 25 treated with remdesivir, showing lower mortality with treatment.
Aug 2020, J. Antimicrobial Chemotherapy, https://academic.oup.com/jac/article/75/11/3359/5896161, https://c19p.org/pasquinis

67. Alshamrani et al., Comprehensive evaluation of six interventions for hospitalized patients with COVID-19: A propensity score matching study

1,324 patient remdesivir late treatment PSM study: 17% lower mortality (p=0.003), 4% lower progression (p=0.12), 43% longer ICU admission (p=0.003), and 7% shorter hospitalization (p=0.25).
PSM retrospective 29 hospitals in Saudi Arabia, showing lower mortality with remdesivir treatment.
Feb 2023, Saudi Pharmaceutical J., https://www.sciencedirect.com/science/article/pii/S1319016423000348, https://c19p.org/alshamranis

68. Fried et al., Patient Characteristics and Outcomes of 11,721 Patients with COVID19 Hospitalized Across the United States

11,721 patient remdesivir late treatment study: 61% lower mortality (p=0.02) and 37% higher ventilation (p=0.25).
Database analysis of 11,721 hospitalized patients, 48 treated with remdesivir. Data inconsistencies have been found in this study, for example 99.4% of patients treated with HCQ were treated in urban hospitals, compared to 65% of untreated patients (Supplemental Table 3), while patients are distributed in a more balanced manner between teaching or not-teaching hospitals, as well as in the most urbanized (Northeast) and less urbanized (Midwest) regions of the United States [academic.oup.com].
Aug 2020, Clinical Infectious Disease, https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1268/5898276, https://c19p.org/frieds

69. Raad et al., International Multicenter Study Comparing Cancer to Non-Cancer Patients with COVID-19: Impact of Risk Factors and Treatment Modalities on Survivorship

remdesivir late treatment study: 42% lower mortality (p=0.009).
Retrospective 3,966 COVID-19 patients, 1,115 with cancer, showing lower mortality with remdesivir and higher mortality with convalescent plasma.
Aug 2022, medRxiv, https://www.medrxiv.org/content/10.1101/2022.08.25.22279181, https://c19p.org/raad2

70. Mozaffari et al., Remdesivir reduced mortality in immunocompromised patients hospitalized for COVID-19 across variant waves: Findings from routine clinical practice.

19,510 patient remdesivir late treatment PSM study: 25% lower mortality (p<0.0001).
Retrospective 19,184 immunocompromised patients treated with remdesivir and matched controls, showing lower mortality with treatment. Several authors work at Gilead and the study was funded by Gilead. The majority of patients were treated with remdesivir. A significant fraction of non-remdesivir patients may have contraindications that also increase risk. Authors provide serum creatine for 26% of the cohort, but notably provide only median and IQR, not allowing comparison of the number of patients with high values. Authors state that "renal function was not significantly different" between remdesivir and non-remdesivir patients, but this does not seem realistic given the prevalence of renal impairment and the contraindictions for remdesivir.
Aug 2023, Clinical Infectious Diseases, https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciad460/7240094, https://c19p.org/mozaffari2

71. Diaz et al., Remdesivir and Mortality in Patients with COVID-19

1,138 patient remdesivir late treatment study: 35% lower mortality (p=0.01).
Retrospective 1138 hospitalized patients in the USA, 286 treated with remdesivir, showing lower mortality with treatment. Age was not included in the adjustments (authors excluded variables that contributed to another score, in this case age is in Pneumonia Severity Index).
Aug 2021, Clinical Infectious Diseases, https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab698/6352176, https://c19p.org/diaz

72. Spinner et al., Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19A Randomized Clinical Trial

584 patient remdesivir late treatment RCT: 35% lower mortality (p=0.5).
Late stage (median 8 days from symptom onset) RCT 584 patients with moderate COVID-19 showing (non-statistically significant) lower mortality. 5-day remdesivir had significantly higher odds of a better clinical status distribution on the 7-point ordinal scale, odds ratio OR 1.65, p = 0.02. The difference for 10-day remdesivir was not statistically significant, p=0.18.
Aug 2020, JAMA, https://jamanetwork.com/journals/jama/fullarticle/2769871, https://c19p.org/spinner

73. Flisiak et al., Remdesivir-based therapy improved recovery of patients with COVID-19 in the SARSTer multicentre, real-world study

333 patient remdesivir late treatment study: 49% lower mortality (p=0.18) and 56% greater improvement (p=0.01).
Retrospective study comparing 122 remdesivir patients and 211 lopinavir/ritonavir patients, showing higher rates of clinical improvement with remdesivir and lower mortality (not statistically significant).
Nov 2020, Polish Archives of Internal Medicine, https://www.mp.pl/paim/issue/article/15735, https://c19p.org/flisiak

74. Siraj et al., Efficacy of Various Treatment Modalities on Patient-related Outcome in Hospitalized COVID-19 Patients – A Retrospective Study

1,000 patient remdesivir late treatment study: 53% lower mortality (p<0.0001).
Retrospective 1,000 COVID+ hospitalized patients in India, showing lower mortality with famotidine and remdesivir in multivariable logistic regression.
Feb 2022, Indian J. Clinical Practice, https://ijcp.in/Admin/CMS/PDF/6.%20OriginalResearch_IJCP_Feb2022.pdf, https://c19p.org/sirajs

75. Olender et al., Remdesivir for Severe Coronavirus Disease 2019 (COVID-19) Versus a Cohort Receiving Standard of Care

1,130 patient remdesivir late treatment study: 59% lower mortality (p=0.001).
Comparative analysis between remdesivir trial GS-US-540–5773 and a retrospective SOC cohort with similar inclusion criteria, showing lower mortality and higher recovery at day 14 with remdesivir.
Jul 2020, Clinical Infectious Diseases, https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1041/5876045, https://c19p.org/olender

76. Piccicacco et al., Real-world effectiveness of early remdesivir and sotrovimab in the highest-risk COVID-19 outpatients during the Omicron surge

172 patient remdesivir early treatment study: 30% lower hospitalization (p=0.47), 52% fewer combined hospitalization/ER visits (p=0.05), and 78% lower progression (p=0.03).
Retrospective high-risk outpatients in the USA, 82 treated with remdesivir, 88 with sotrovimab, and 90 control patients, showing significantly lower combined hospitalization/ER visits with both treatments in unadjusted results. The dominant variant was omicron B.1.1.529.
Jul 2022, J. Antimicrobial Chemotherapy, https://academic.oup.com/jac/advance-article/doi/10.1093/jac/dkac256/6652940, https://c19p.org/piccicaccos

77. Beigel et al., Remdesivir for the Treatment of Covid-19 — Final Report

1,062 patient remdesivir late treatment RCT: 27% lower mortality (p=0.07) and 22% improved recovery (p=0.0005).
RCT 1,062 hospitalized patients showing faster recovery time with treatment, median 10 days vs. 15 days for placebo, rate ratio for recovery 1.29, p<0.001. Day 29 mortality was 11.4% with remdesivir and 15.2% with placebo, hazard ratio HR 0.73 [0.52-1.03].
Oct 2020, NEJM, https://www.nejm.org/doi/full/10.1056/NEJMoa2007764, https://c19p.org/beigel

78. Ali et al., Remdesivir for the treatment of patients in hospital with COVID-19 in Canada: a randomized controlled trial

1,281 patient remdesivir late treatment RCT: 12% lower mortality (p=0.21), 47% lower ventilation (p=0.0003), 9% improved recovery (p=0.41), and 11% longer hospitalization (p=0.04).
RCT 1,282 hospitalized patients in Canada showing lower mechanical ventilation with remdesivir treatment, but no significant difference for mortality.
Jan 2022, Canadian Medical Association J., http://www.cmaj.ca/lookup/doi/10.1503/cmaj.211698, https://c19p.org/ali5

79. Jittamala et al., Clinical antiviral efficacy of remdesivir in COVID-19: an open label, randomized, controlled adaptive platform trial (PLATCOV)

136 patient remdesivir early treatment RCT: 29% improved viral clearance (p<0.0001).
High conflict of interest RCT with very low risk patients with high existing immunity, showing faster viral clearance with remdesivir. The viral clearance half-life was very short in both arms. With rapid viral clearance and very low risk patients, the trial favors detecting an effect with intravenous treatments that have rapid onset of action.
Jul 2023, The J. Infectious Diseases, https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiad275/7226765, https://c19p.org/jittamala

80. Gottlieb et al., Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients

562 patient remdesivir early treatment RCT: 87% lower combined mortality/hospitalization (p=0.008), 72% lower hospitalization (p=0.009), and 29% improved recovery (p=0.31).
RCT high-risk outpatients, 279 treated with remdesivir and 283 control patients, median 5 days from symptoms, showing significantly lower hospitalization with treatment.
Dec 2021, New England J. Medicine, https://www.nejm.org/doi/full/10.1056/NEJMoa2116846, https://c19p.org/gottlieb2

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