Publication date: Jun 20, 2025

Significant heterogeneity has been reported in cohort studies evaluating the impact of antiviral treatment on long-term sequelae following COVID-19 hospitalisation. We evaluated the impact of intravenous (IV) remdesivir on risk of subsequent long-term cardiovascular/neurological/respiratory/autoimmune diagnoses and persistent symptoms. National COVID-19 registries and healthcare claims databases were utilised to construct a retrospective population-based cohort enrolling all adult Singaporeans hospitalised for COVID-19 (1 Sept 2021-31 Jul 2023), who fulfilled criteria for IV 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. 30,175 COVID-19 hospitalisations were included in the cohort for evaluating risk of long-term sequelae; 37. 6% (11,353/30,175) received remdesivir. 88. 9% of the cohort were fully-vaccinated, and 60. 5% had received a booster dose; 77. 4% were infected during Omicron. Risk of long-term new-onset diagnoses across cardiovascular, neurological, respiratory and autoimmune systems (any long-term diagnosis, adjusted-hazards-ratio, aHR=1. 08[95%CI=0. 97-1. 20]) up to 300 days post-COVID-19-hospitalisation 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-hospitalisation was observed in the remdesivir-treated group, versus untreated individuals. Receipt of remdesivir did not significantly reduce risk of long-term multi-systemic sequelae or long-term symptoms in a boosted cohort of adult Singaporeans hospitalised with COVID-19.

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