IntroductionRemdesivir exerts positive effects on clinical improvement, even though it seems not to affect mortality among COVID-19 patients; moreover, it was associated with the occurence of marked bradycardia.MethodsWe retrospectively evaluated 989 consecutive patients with non-severe COVID-19 (SpO2≥ 94% on room air) admitted from October 2020 to July 2021 at five Italian hospitals. Propensity score matching allowed to obtain a comparable control group. Primary endpoints were bradycardia onset (heart rate < 50 bpm), acute respiratory distress syndrome (ARDS) in need of intubation and mortality.ResultsA total of 200 patients (20.2%) received remdesivir, while 789 standard of care (79.8%). In the matched cohorts, severe ARDS in need of intubation was experienced by 70 patients (17.5%), significantly higher in the control group (68% vs. 31%;p< 0.0001). Conversely, bradycardia, experienced by 53 patients (12%), was significantly higher in the remdesivir subgroup (20% vs. 1.1%;p< 0.0001). During follow-up, all-cause mortality was 15% (N= 62), significantly higher in the control group (76% vs. 24%; log-rankp< 0.0001), as shown at the Kaplan–Meier (KM) analysis. KM furthermore showed a significantly higher risk of severe ARDS in need of intubation among controls (log-rankp< 0.001), while an increased risk of bradycardia onset in the remdesivir group (log-rankp< 0.001). Multivariable logistic regression showed a protective role of remdesivir for both ARDS in need of intubation (OR 0.50, 95%CI 0.29–0.85;p= 0.01) and mortality (OR 0.18, 95%CI 0.09–0.39;p< 0.0001).ConclusionsRemdesivir treatment emerged as associated with reduced risk of severe acute respiratory distress syndrome in need of intubation and mortality. Remdesivir-induced bradycardia was not associated with worse outcome.