University of North Carolina at Chapel Hill

Effectiveness of Remdesivir Treatment Protocols Among Patients Hospitalized with COVID-19: A Target Trial Emulation

Authors: M. Alan Brookhart, PhDJulie M. CrawfordAndrea R. MospanMichael W. Fried, MD, FAASLD

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Challenge

Remdesivir became a standard of care for hospitalized COVID-19 patients, but its real-world effectiveness across different initiation timing protocols—accounting for time-varying treatment decisions—had not been estimated using rigorous causal methods.

Solution

Target RWE researchers applied the clone-censor-weight design to a large hospital chargemaster dataset to compare remdesivir treatment protocols, accounting for time-varying patient characteristics that determine both treatment timing and outcomes.

Impact

Demonstrating that early remdesivir initiation significantly reduces in-hospital mortality when analyzed with causal methods validates clone-censor-weighting as Target RWE's approach for complex treatment timing questions, supporting Gilead's post-authorization effectiveness evidence strategy.