OBJECTIVE: Remdesivir is the only intravenous antiviral used for the treatment of COVID-19 at Maimonides Medical Center (MMC). The purpose of this evaluation was to assess the appropriateness of remdesivir use in accordance with the current MMC adult COVID-19 treatment guidelines.

METHODS: We conducted a medication-use evaluation of remdesivir orders between September 1, 2024 and December 31, 2024. Adult patients aged ≥18 years who received at least one dose of remdesivir were included. No patients were excluded. The primary outcome was the percentage of appropriate remdesivir orders, defined as having appropriate indication, dose, and duration. Secondary outcomes included percentage of appropriate steroid use, percentage of Infectious Diseases (ID) attending approvals, and in-hospital mortality. Descriptive statistics were utilized to analyze the data, including percentages for categorical variables and medians with interquartile ranges (IQR) for continuous variables.

RESULTS: A total of 78 patients were included. The median age was 77.5 years (IQR 68-88) and 42 patients (54%) were male. For the primary outcome, 56 remdesivir orders (72%) were appropriate. Of the remaining inappropriate orders, 14 orders (18%) had an inappropriate duration; seven patients (9%) were not indicated for remdesivir; one patient (1%) did not receive a loading dose of remdesivir. Fifty-nine patients (76%) had appropriate steroid use. Forty-seven remdesivir orders (60%) were approved by ID attendings with 28 (36%) being approved by an ID fellow. The in-hospital mortality was 12% – six patients died due to COVID-related causes and one patient died of an unknown cause.

CONCLUSION AND IMPACT: This evaluation found that 72% of remdesivir orders were appropriate, indicating good but incomplete adherence to the current MMC adult COVID-19 treatment guidelines. Targeted opportunities for improvement include optimizing treatment duration, restricting remdesivir use to patients with confirmed COVID-19 infection, and ensuring appropriate concomitant steroid use.