Early administration of the intravenous antiviral drug remdesivir (RDV) may decrease 28-day mortality rates for hospitalized COVID-19 adults suffering from liver or kidney disease, as published today in Clinical Infectious Diseases by researchers from Gilead Sciences and the University of Illinois.
Early Remdesivir Impact on Hospitalized Kidney Patients
Among hospitalized adults with kidney disease and COVID-19, early initiation of remdesivir is associated with a 25% lower risk of 28-day all-cause in-hospital death compared with controls who did not receive the antiviral, according to the University of Illinois and Gilead Sciences researchers. The study analyzed U.S. medical claims and hospital cost data from 2021 to 2025. Patrick Godwin, MD, a clinical professor of medicine at the University of Illinois College of Medicine in Chicago, spearheaded the assessment examining patient outcomes who faced elevated vulnerabilities for adverse prognoses.
The matched renal cohort evaluated by researchers included 13,798 patients overall, with a total study population of 22,378 patients split evenly between remdesivir recipients and control groups. This group included individuals requiring renal replacement therapy in the year prior to treatment. While nearly 70% of patients in the cohort required supplemental oxygen, patients with kidney disease who received oxygen saw a 25% lower risk of death with early remdesivir use, according to findings published in Clinical Infectious Diseases.
Did you know? Remdesivir, marketed under the brand name Veklury by Gilead Sciences, is metabolized primarily through the liver, making hepatic laboratory testing recommended before and during treatment according to study authors.
Mortality Reduction in Patients With Preexisting Liver Disease
Patients with preexisting hepatic conditions—such as liver injury, cirrhosis, liver failure, and noninfectious hepatitis—experienced a 24% lower risk of 28-day in-hospital death when given early remdesivir, according to the Clinical Infectious Diseases report. Gina Shaw noted that the matched hepatic cohort in the retrospective analysis included 4,968 patients, demonstrating an overall mortality rate of 4.59%.
Dr. Godwin and his research colleagues found that the survival benefit extended across various levels of respiratory support. Hepatic patients who received supplemental oxygen at admission realized a 26% lower mortality risk with early treatment. Meanwhile, liver patients who did not require supplemental oxygen experienced a 49% lower risk of death, according to the University of Illinois data.
Pro Tip: Researchers used coarsened exact matching and 1:1 propensity score matching in their retrospective study to balance demographic, clinical, and hospital characteristics between treatment and control populations.
Safety and Clinical Implications for High-Risk Populations
Historically, patients with severe organ dysfunction faced exclusion from clinical trials due to concerns regarding renal or hepatic toxicity. However, a 2025 meta-analysis published in BMC Infectious Diseases found that remdesivir use in patients with severe renal impairment associated with a lower incidence of kidney injury (risk ratio, 0.51) and no significant increase in hepatic disorder or mortality.
Study authors emphasize that individuals infected with SARS-CoV-2 with underlying hepatic or renal comorbidities face higher mortality risk than the general population. The new findings offer clinicians empirical data to inform decision-making for these vulnerable subpopulations, showing that early initiation—defined as treatment upon hospital admission or within the first two days—provides measurable survival benefits.
Frequently Asked Questions
What patients were included in the kidney and liver cohorts?
The kidney cohort featured patients with kidney disease, including those needing renal replacement therapy in the year prior to treatment. The liver cohort included patients diagnosed with liver injury, cirrhosis, liver failure, and noninfectious hepatitis, according to researchers.
Did patients not requiring supplemental oxygen benefit from remdesivir?
Yes. Liver patients who did not receive supplemental oxygen experienced a 49% lower risk of death with early remdesivir use, according to the study data. A similar decrease observed in kidney patients not requiring oxygen was not statistically significant.
Who funded or conducted the study?
The research was conducted by scientists from the University of Illinois and drug maker Gilead Sciences. Dr. Patrick Godwin reported financial relationships with Gilead Sciences, and co-authors included employees or stockholders of the company, according to disclosures reported by Gina Shaw.
What are your thoughts on these findings? Join the discussion by leaving a comment below, share this article with colleagues, or subscribe to our newsletter for the latest clinical updates.