Real-world effectiveness of remdesivir in immunocompromised patients hospitalized due to SARS-CoV-2 Infection: Insights to inform pharmacy practice

PURPOSE: Immunocompromised adults hospitalized for coronavirus disease 2019 (COVID-19) remain at high risk for morbidity. Despite remdesivir's approval for treatment of COVID-19, real-world evidence on its early use, particularly in patients infected with evolving Omicron-era subvariants, remains limited. Contemporary evidence is essential to support hospital pharmacy practice and antiviral stewardship. METHODS: We conducted a retrospective cohort study using the Premier Healthcare Database. Adult immunocompromised patients hospitalized for COVID-19 from December 2021 to December 2024 were included. Patients with COVID-19 present-on-admission who received remdesivir within the first 2 hospital days were compared to untreated patients using 1:1 propensity score matching. The outcomes assessed were 14- and 28-day all-cause mortality. Subgroup analyses assessed outcomes stratified by oxygen requirements and specific immunocompromising conditions. RESULTS: Among 22,808 matched patients, early remdesivir use was associated with significantly lower 14-day (hazard ratio [HR], 0.75; 95% CI, 0.69-0.82; P < 0.0001) and 28-day mortality (HR, 0.80; 95% CI, 0.74-0.86; P < 0.0001). Mortality reductions were observed across early and later Omicron periods and among patients with or without supplemental oxygen requirements. Subgroup analyses showed similar survival benefit in patients with cancer, including hematologic malignancies, as well as transplant recipients. CONCLUSIONS: Early remdesivir initiation was associated with clinically meaningful and significant survival benefits in immunocompromised patients hospitalized for COVID-19, with these associations persisting in the Omicron subvariant era. These findings highlight the potential benefit of early antiviral treatment in this vulnerable population while underscoring the need for further prospective studies, including randomized controlled trials, to confirm causal effects and refine treatment strategies. Clinical pharmacists have a pivotal role in ensuring institutional protocols remain aligned with current evidence so that eligible high-risk patients consistently receive appropriate therapy.