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Published on: February 27, 2026
Practical Application of Remdesivir-Based Regimens in COVID-19: A Retrospective Case-Control Analysis
Alireza Nikoonejad1, Mahsa Mahmoudi1, Sara Nazemsadati1
1Department of Infectious Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
Medical Journal of the Islamic Republic of Iran
|July 28, 2026
Summary
This study found that remdesivir (RDV) use in hospitalized COVID-19 patients reduced intubation risk but did not significantly impact mortality or ICU admission. However, remdesivir treatment was associated with longer hospital stays.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Health Services Research
Background:
- The COVID-19 pandemic necessitated the evaluation of inpatient treatments.
- Observational studies on remdesivir (RDV) effectiveness are prone to confounding factors.
- Propensity score matching (PSM) was employed to assess real-world RDV effectiveness.
Purpose of the Study:
- To evaluate the real-world effectiveness of remdesivir (RDV)-based regimens in hospitalized COVID-19 patients.
- To mitigate confounding by indication and temporal trends in treatment comparisons.
- To analyze the impact of RDV on mortality, ICU admission, intubation, and length of stay.
Main Methods:
- A single-center retrospective cohort study of 2,216 adult COVID-19 patients.
- Propensity score matching (PSM) was used to create comparable groups of RDV and non-RDV recipients.
- Outcomes included hospital mortality, ICU admission, intubation, and length of stay, analyzed using logistic regression and GEE models.
Main Results:
- Propensity score matching created 1,108 well-matched pairs, though minor imbalances persisted.
- Remdesivir (RDV) use was associated with significantly lower intubation risk (OR 0.50).
- No significant differences were observed for ICU admission or mortality; however, RDV users had a longer length of stay (+1.52 days).
Conclusions:
- Remdesivir (RDV) use in hospitalized COVID-19 patients was linked to reduced intubation rates but not improved survival or reduced ICU admission.
- Longer hospital stays were observed in patients receiving RDV.
- Residual confounding and unmeasured variables limit definitive causal inference, necessitating further research for personalized treatment strategies.
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