Clinical outcomes of remdesivir in patients with COVID-19 infection: An observational study from a tertiary care hospital in Pakistan


  • Sher Muhammad Sethi Aga Khan University Hospital, Karachi Pakistan
  • Memoona Irshad Pakistan Kidney & Liver Institute and Research Centre, Karachi Pakistan
  • Roodaba Iqbal Aga Khan University Hospital, Karachi



Background: The primary objective was to assess the change in oxygenation status of patients after remdesivir treatment.

Material and Methods: This retrospective cross-sectional study was conducted at the Aga Khan University Hospital, Karachi from September to December 2020. All patients aged >18 years admitted with a positive reverse transcriptase-polymerase chain reaction for COVID-19 were included. Infection severity was subcategorized into two groups (moderate-to-severe and critical). We compared oxygenation status and assisted ventilation before and after remdesivir treatment. An analysis of outcomes between the groups was conducted using chi squares and the student t-test at a significance level of <0.05.

Results: We had 213 COVID-19 patients, of whom 114 (53.5%) received remdesivir during their hospital stay. 69 (60.5%) patients were male and the mean age was 52±12 years. 56 patients (49.1%) had moderate-to-severe infections. 21 out of 56 patients (37.5%) with moderate-to-severe COVID-19 infection while 47 out of 58 patients (81%) with critical COVID-19 required oxygen following remdesivir treatment (p-value: <0.001). Out of 58 critical COVID-19 patients, 46 patients (79.3%) were on non-invasive ventilation and 12 patients (20.7%) were on invasive ventilation prior to remdesivir therapy. 22 out of 46 patients (47.8%) recovered from non-invasive ventilation after remdesivir treatment (p-value: <0.001). 15 patients had mortality (13.1%) while the mean length of hospital stay with moderate-to-severe COVID-19 infection was 6.8 days and with critical COVID-19 infection was 11.3 days.

Conclusion: The study emphasizes that remdesivir was found to be clinically beneficial in patients with moderate-to-severe COVID-19 infection. Besides improving oxygenation status, it also reduced mortality and shortened hospital stays.

Keywords: Antiviral drug, COVID-19, Hypoxia, Noninvasive ventilation, Severe acute respiratory distress syndrome


COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Available at

Sharing WiIRFI. World Health Organization. Regional Office for the Eastern Mediterranean. (2015‎. Country factsheet insufficient physical activity: Pakistan. World Health Organization. Regional Office for the Eastern Mediterranean:

Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020;91(1):157-60. DOI:

Kalil AC. Treating COVID-19-Off-Label drug use, compassionate use, and randomized clinical trials during pandemics. JAMA. 2020. DOI:

Mulangu S, Dodd LE, Davey RT Jr, Mbaya OT, Proschan M, Mukadi D, et al. A randomized, controlled trial of Ebola virus disease therapeutics. N Engl J Med. 2019; 381(24): 2293-303. DOI:

Wang Y, Zhang D, Du G, Du R, Zhao J, Jin Y, et al. Remdesivir in adults with severe COVID-19: A randomized, double-blind, placebo-controlled, multicentre trial. Lancet. 2020; 395(10236): 1569-78. DOI:

Grein J, Ohmagari N, Shin D, Diaz G, Asperges E, Castagna A, et al. Compassionate use of remdesivir for patients with severe Covid-19. N Engl J Med. 2020; 382(24): 2327-36. DOI:

Aleissa MM, Silverman EA, Paredes Acosta LM, Nutt CT, Richterman A, Marty FM. New Perspectives on Antimicrobial Agents: Remdesivir Treatment for COVID-19. Antimicrob Agents Chemother. 2020; 65(1). DOI:

Rehman SU, Rehman SU, Yoo HH. COVID-19 challenges and its therapeutics. Biomed Pharmacother. 2021; 142: 112015. DOI:

Adhikari S, Khadka S, Dahal S, Shrestha DB, Shahi J, Bajgain Y. Remdesivir in COVID-19 management: availability and relevance to low- and middle-income countries. Drugs Ther Perspect. 2021;37(1):26-8. DOI:

Gao YD, Ding M, Dong X, Zhang JJ, Kursat Azkur A, Azkur D, et al. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy. 2021;76(2):428-55. DOI:

Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. 2020;383(19):1813-26. DOI:

Young B, Tan TT, Leo YS. The place for remdesivir in COVID-19 treatment. Lancet Infect Dis. 2021;21(1):20-1. DOI:

Hsu J. Covid-19: What now for remdesivir? BMJ. 2020; 371:m4457. DOI:

Spinner CD, Gottlieb RL, Criner GJ, Arribas Lopez JR, Cattelan AM, Soriano Viladomiu A, et al. Effect of remdesivir vs standard care on clinical status at 11 days in patients with moderate COVID-19: A Randomized Clinical Trial. JAMA. 2020; 324(11): 1048-57. DOI:

Ansems K, Grundeis F, Dahms K, Mikolajewska A, Thieme V, Piechotta V, et al. Remdesivir for the treatment of COVID-19. Cochrane Database Syst Rev. 2021;8: CD014962. DOI:

Norrie JD. Remdesivir for COVID-19: Challenges of underpowered studies. Lancet. 2020; 395(10236): 1525-7. DOI:

Mahajan L, Singh AP, Gifty. Clinical outcomes of using remdesivir in patients with moderate to severe COVID-19: A prospective randomised study. Indian J Anaesth. 2021; 65(Suppl 1): S41-S6. DOI:

Abd-Elsalam S, Salama M, Soliman S, Naguib AM, Ibrahim IS, Torky M, et al. RETRACTED: Remdesivir Efficacy in COVID-19 Treatment: A Randomized Controlled Trial. Am J Trop Med Hyg. 2021; 106(3): 886-90. DOI:

Diaz GA, Christensen AB, Pusch T, Goulet D, Chang SC, Grunkemeier GL, et al. Remdesivir and mortality in patients with coronavirus disease 2019. Clin Infect Dis. 2022; 74(10): 1812-20. DOI:

Finn A, Jindal A, Andrea SB, Selvaraj V, Dapaah-Afriyie K. Association of Treatment with Remdesivir and 30-day Hospital Readmissions in Patients Hospitalized with COVID-19. Am J Med Sci. 2022; 363(5): 403-10.


Sethi SM, Ahmed AS, Hanif S, Aqeel M, Zubairi ABS. Subcutaneous emphysema and pneumomediastinum in patients with COVID-19 disease; case series from a tertiary care hospital in Pakistan. Epidemiol Infect. 2021;149:e37.


Sethi SM, Hanif S, Iqbal M. Association of thrombosis and mortality in patients with COVID-19 infections: a hospital-based observational study. Egypt J Intern Med. 2022; 34(1): 66. DOI: