Lower mortality risk associated with remdesivir plus corticosteroids vs corticosteroids alone for the treatment of patients hospitalized with SARS-CoV-2 infection in the early and later Omicron periods

Purpose Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to pose a risk to vulnerable populations. This retrospective study compared the effectiveness of remdesivir plus corticosteroids (CCS) versus CCS alone in patients hospitalized with COVID-19 from December 2021 to December 2024. Methods Data were extracted from the large, geographically-diverse US Premier Healthcare Database for adults hospitalized for COVID-19. Exclusion criteria included pregnancy, incomplete data, transfer from another hospital or hospice care, death/discharge during the baseline period, elective procedure admissions, patients without supplemental oxygen in hospitals that did not report charges for low-flow oxygen, and patients on extracorporeal membrane oxygenation. Propensity scores were estimated to balance the distribution of underlying confounders. A sensitivity analysis was performed using inverse probability of treatment weighting. Results A total of 104,900 patients were initiated on remdesivir plus CCS and 66,016 were initiated on CCS alone in the first 2 days of hospitalization. Unadjusted 14- and 28-day mortality rates were lower for remdesivir-treated patients versus patients who did not receive remdesivir during hospitalization. Remdesivir plus CCS initiation upon admission for COVID-19 (in the total population) was associated with a significantly lower mortality rate (P < 0.0001) (in the overall Omicron period) at both 14 and 28 days, with an adjusted hazard ratio (95% CI) of 0.77 (0.74-0.80) and 0.79 (0.77-0.82), respectively, versus CCS alone. Results were similar for the total population in the early and later Omicron periods. Conclusion Remdesivir plus CCS was associated with a significant reduction in inpatient all-cause mortality relative to CCS alone in patients hospitalized for COVID-19 across 3 years of the Omicron period, illustrating the utility of the most recent real-world evidence to help inform treatment recommendations for inpatient providers treating patients with SARS-CoV-2 infection.