Efficacy and Cardiovascular Safety of Remdesivir in COVID-19: A Case-Control Study

Background: The Food and Drug Administration (FDA) has approved remdesivir under emergency use authorization for the management of the early stage of Coronavirus Disease (COVID-19). Since remdesivir has been approved on a ‘fast-track’ basis, the real-life efficacy and its safety on different population subsets have not been studied in detail so far. This study aimed to investigate the real-life efficacy with a special focus on the cardiovascular safety of remdesivir in the management of COVID-19. Materials and Methods: This is a single-centered, case-control study conducted from April 2022 to March 2023 in 427 case records and 301 records (181 under remdesivir and 120 in the control group) were analyzed. Results: In the severe COVID-19 category, the remdesivir group has significant AST, ALT, blood urea, and serum creatinine elevation when compared to the baseline values. Remdesivir is associated with a significant increase in the occurrence of QT prolongation during therapy (Odds ratio [QT]=3.18 (95% Confidence Interval [CI] 1.13 to 8.93; p=0.038). The Remdesivir group does not differ significantly in all-cause mortality in COVID-19 when compared with that of the control group (35.4% Vs. 33.3%; p=0.804). Conclusion: The use of remdesivir in COVID-19 patients did not reduce all-cause mortality and it is not associated with protective mortality outcomes. Remdesivir causes increased incidence of QT prolongation, bradycardia, and elevation of AST, ALT, Blood urea, and serum creatinine levels in COVID-19 patients.