ArticleInfection and drug resistance2026
Effect of Remdesivir on Mortality in Mechanically Ventilated COVID-19 Patients: A Target Trial Emulation Using Inverse Probability of Treatment Weighting.
Article in Infection and drug resistance, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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4 authors.
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Abstract
Background: The efficacy of remdesivir in critically ill COVID-19 patients requiring mechanical ventilation remains controversial. Although current guidelines recommend against routine use in this population, clinical practice varies. We evaluated the association between remdesivir and mortality using a target trial emulation framework. Methods: This retrospective cohort study included adult COVID-19 patients requiring endotracheal intubation within 7 days of diagnosis at a tertiary medical center in Taiwan (January 2021-March 2024). Remdesivir exposure was defined as in-hospital initiation of standard-dose remdesivir within 3 days of COVID-19 diagnosis (the grace period; diagnosis date defined as time zero), continued for at least 3 consecutive days. Stabilized inverse probability of treatment weighting (S-IPTW) using 15 baseline covariates was applied. Primary outcomes were overall and 90-day mortality; secondary outcome was mechanical ventilation duration. Results: Among 163 eligible patients, 117 (71.8%) received remdesivir. After S-IPTW weighting, covariates were well balanced (maximum |SMD|=0.148). Remdesivir was associated with increased overall mortality (HR 2.52; 95% CI 1.24-5.15; p=0.011) and prolonged mechanical ventilation (HR 2.79; 95% CI 1.37-5.68; p=0.005). A similar trend was observed for 90-day mortality (HR 2.09; 95% CI 0.97-4.48; p=0.060). Findings were consistent after excluding ECMO users (overall mortality HR 2.68; 95% CI 1.27-5.62; p=0.009). E-values suggested moderate robustness to unmeasured confounding. Conclusion: In mechanically ventilated COVID-19 patients, remdesivir use was associated with, but not proven to cause, increased mortality and longer ventilation duration; these observational findings align with guideline recommendations against routine initiation in this setting.
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