Remdesivir and risk of long-term multi-systemic sequelae following COVID-19 hospitalization.

Objectives: Significant heterogeneity has been reported in cohort studies evaluating the impact of antiviral treatment on long-term sequelae following COVID-19 hospitalization. We evaluated the impact of i.v. remdesivir on the risk of subsequent long-term cardiovascular/neurological/respiratory/autoimmune diagnoses and persistent symptoms.

Methods: National COVID-19 registries and health care claims databases were utilized to construct a retrospective population-based cohort enrolling all adult Singaporeans hospitalized for COVID-19 (September 1, 2021-July 31, 2023) who fulfilled criteria for intravenous remdesivir. The cohort was divided into remdesivir-treated and untreated groups, with between group differences in baseline sociodemographic and clinical characteristics adjusted using overlap weighting. Risks of long-term new-incident (31-300 days) diagnoses/symptoms across cardiovascular/neurological/respiratory/autoimmune systems were compared across untreated/treated groups via competing-risks regression.

Results: A total of 30 175 COVID-19 hospitalizations were included in the cohort for evaluating risk of long-term sequelae; 37.6% (11 353/30 175) received remdesivir. A total of 88.9% of the cohort were fully vaccinated, and 60.5% had received a booster dose; 77.4% were infected during Omicron. The risk of long-term new-onset diagnoses across cardiovascular, neurological, respiratory, and autoimmune systems (any long-term diagnosis, adjusted hazards ratio = 1.08 [95% CI, 0.97-1.20]) up to 300 days post-COVID-19-hospitalization was not significantly different in the remdesivir-treated group versus untreated individuals across age and vaccination subgroups. Similarly, no significant difference in the incidence of long-term symptom persistence at 300 days post-COVID-19 hospitalization was observed in the remdesivir-treated group versus untreated individuals.

Discussion: Receipt of remdesivir did not significantly reduce risk of long-term multisystemic sequelae or long-term symptoms in a boosted cohort of adult Singaporeans hospitalized with COVID-19.