Medical Journal of the Islamic Republic Of Iran

en Practical Application of Remdesivir-Based Regimens in COVID-19: A Retrospective Case-Control Analysis Infectious Disease Infectious Disease Original Research Original Research Background: The SARS-CoV-2 pandemic strained global healthcare, creating a demand for effective inpatient treatments. Observational comparisons of remdesivir (RDV) versus non-RDV are subject to confounding by indication and temporal trends. This study assessed the real-world effectiveness of RDV-based regimens using propensity score matching (PSM).    Methods: We conducted a single-center retrospective cohort study at BouAli Hospital, analyzing 2,216 adults hospitalized with COVID-19 between March and September 2020. The propensity score for RDV receipt was estimated via logistic regression including age, admission SpO₂, comorbidities, vaccination status, adjunct therapies, and pandemic wave. Patients were matched 1:1 by nearest neighbor (caliper 0.2 SD, common support). Covariate balance was assessed using standardized mean differences (SMD). Outcomes included hospital mortality, ICU admission, intubation, and length of stay (LOS).    Results: PSM produced 1,108 well-matched pairs (n=2,216). Some imbalance persisted (largest |SMD|: atorvastatin 0.35; vaccination 0.35; wave 0.24; age 0.17). RDV was associated with a lower intubation risk (OR 0.50, 95% CI 0.39–0.65; P<0.001) but not ICU admission (OR 0.89, 95% CI 0.72–1.09; P=0.286) or mortality (OR ≈1.0, ns). LOS was longer in RDV users (median +1.52 days; P<0.001). Doubly adjusted GEE models confirmed these findings (intubation OR 0.60, 95% CI 0.42–0.87; P=0.007; ICU OR 1.21, 95% CI 0.84–1.75; ns).    Conclusion: After PSM and adjustment, RDV use was linked to reduced intubation but not ICU admission or mortality, with longer hospital stays observed. Residual imbalance and unmeasured severity limit causal inference. Further studies are needed to guide personalized COVID-19 treatment.   COVID-19, Remdesivir, Intensive Care Unit (ICU) admission, Mortality, Intubation, Retrospective study 69 73 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-974-11&slc_lang=en&sid=1 Alireza Nikoonejad nikoonejad.anikoo@gmail.com 200319475328460096512 200319475328460096512 No Department of Infectious Diseases, Qazvin University of Medical Sciences, Qazvin, Iran Mahsa Mahmoudi drmahsamahmoudi79@gmail.com 200319475328460096513 0009-0005-3548-7343 No Department of Infectious Diseases, Qazvin University of Medical Sciences, Qazvin, Iran Sara Nazemsadati s.nazemsadati@qums.ac.ir 200319475328460096514 200319475328460096514 No Department of Infectious Diseases, Qazvin University of Medical Sciences, Qazvin, Iran Ehsan Ahmadi ehsanahmadi0013@gmail.com 200319475328460096515 0009-0002-2378-3207 No Institute for Advanced Studies in Basic Sciences, Zanjan, Zanjan, Iran Abbas Allami allami@qums.ac.ir 200319475328460096516 200319475328460096516 Yes Department of Infectious Diseases, Qazvin University of Medical Sciences, Qazvin, Iran