Safety and effectiveness of remdesivir in COVID-19 patients with liver dysfunction: a retrospective cohort study

This study aimed to assess the safety and effectiveness of remdesivir in hospitalized COVID-19 patients with liver dysfunction.

A retrospective cohort study analyzed medical records of 268 patients hospitalized between 2019 and 2022 with COVID-19 and elevated liver enzymes (AST and ALT). Patients were divided into remdesivir (N = 134) and non-remdesivir (N = 134) groups. Outcomes assessed included in-hospital mortality, 30-day mortality, adverse events, time to clinical improvement, and time to discharge. Statistical analyses included logistic regression with significance at p < 0.05.

A total of 268 patients (134 receiving remdesivir and 134 controls) were included. The remdesivir group was older, had lower oxygen saturation, and presented with more severe disease at baseline. Despite these differences, remdesivir use was associated with a significantly faster clinical recovery (adjusted β = - 2.18 days; 95% CI: - 4.206 to - 0.154; p = 0.035). In-hospital mortality was higher in the remdesivir group (10.45% vs. 7.46%), but this difference was not statistically significant after adjustment (OR 0.12; 95% CI: 0.001-8.390; p = 0.109). Remdesivir nearly doubled the risk of serious adverse events (OR 1.90; 95% CI: 0.988-3.656), although this did not reach statistical significance (p = 0.054). Independent predictors of death or major adverse events included ICU admission, elevated ALP, and concomitant use of certain medications.

Remdesivir appears safe in COVID-19 patients with liver dysfunction and significantly shortens time to clinical improvement without increasing mortality or serious adverse events.

The online version contains supplementary material available at 10.1007/s40200-025-01758-7.