The study evaluated 22,378 patients with kidney disease—divided evenly between remdesivir recipients and control groups—and 5,026 patients with liver disease. Results indicate that the risk of 28-day all-cause in-hospital death dropped by 25% in the kidney cohort and 24% in the liver cohort among those who received early treatment compared to controls. Nearly 70% of all patients across both cohorts required supplemental oxygen during their hospital stay.
Detailed Findings in Renal and Hepatic Subgroups
Stratifying patients by supplemental oxygen use revealed varying degrees of mortality reduction. Among kidney and liver patients who received supplemental oxygen in the first two days after admission, the risk of death was 25% and 26% lower with early remdesivir use, respectively. In liver patients who did not receive supplemental oxygen, the risk of death dropped by 49%. The decrease observed in kidney patients who did not receive supplemental oxygen was not statistically significant.
The kidney cohort included individuals who required renal replacement therapy in the year prior to treatment initiation. The liver cohort comprised patients diagnosed with conditions such as cirrhosis, liver failure, noninfectious hepatitis, and acute liver injury. Because remdesivir is metabolized primarily through the liver, the researchers noted that hepatic laboratory testing is recommended both before and during treatment.
These findings build upon a body of clinical literature examining the timing of antiviral interventions. A single-center observational study published in Wiener klinische Wochenschrift analyzed 350 propensity-score-matched patients and found that while overall in-hospital mortality did not shift significantly across the entire cohort, subgroup analysis showed a substantial mortality reduction in patients treated within seven days of symptom onset. In that European study, early treatment yielded a hazard ratio of 0.26, dropping mortality to 4.2% compared to 10.4% in controls.
Large-scale randomized controlled trials have also evaluated timing and oxygen dependency. The multicenter ACTT-1 trial demonstrated that intravenous remdesivir for up to 10 days reduced the median time to clinical recovery from 15 to 10 days, with effects primarily driven by patients receiving low-flow oxygen. Similarly, updated results from the multinational, open label, randomized platform SOLIDARTY trial showed reduced 28-day mortality in patients requiring oxygen who were not mechanically ventilated.
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