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Molaei E, Molaei A, Hayes AW, Karimi G. Remdesivir: treatment of COVID-19 in special populations. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:3829-3855. [PMID: 38180557 DOI: 10.1007/s00210-023-02927-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/23/2023] [Indexed: 01/06/2024]
Abstract
Remdesivir (RDV) is the mainstay antiviral therapy for moderate to severe COVID-19. Although remdesivir was the first drug approved for COVID-19, information about its efficacy and safety profile is limited in a significant segment of the population, such as people with underlying diseases, the elderly, children, and pregnant and lactating women. The efficacy and safety profile of RDV in disease progression, renal impairment, liver impairment, immunosuppression, geriatrics, pediatrics, pregnancy, and breastfeeding in COVID-19 patients was evaluated. The databases searched included Embase, Scopus, and PubMed. Only English language studies enrolling specific subpopulations with COVID-19 and treated with RDV were included. Thirty-nine clinical trials, cohorts, cross-sectional studies, and case series/reports were included. Most supported the benefits of RDV therapy for COVID-19 patients, such as lessening the duration of hospitalization, alleviating respiratory complications, and reducing mortality. Adverse effects of RDV, including liver and kidney impairment, were, for the most part, moderate to mild, supporting the safety profile of RDV therapy. RDV therapy was well tolerated, no new safety signals were detected, and liver function test abnormalities were the most common adverse events. Moreover, RDV, for the most part, was effective in managing the complications of COVID-19 and reducing mortality in these patients, except for patients with kidney impairment. Future studies, including RCTs, should include these subpopulations of patients to avoid delays associated with receiving proper medication through compassionate use programs.
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Affiliation(s)
- Emad Molaei
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Molaei
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - A Wallace Hayes
- University of South Florida College of Public Health, Tampa, FL, USA
- Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, USA
| | - Gholamreza Karimi
- Pharmaceutical Research Center, Institute of Pharmaceutical Technology, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Pharmacodynamics and Toxicology, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Bai Y, Wang L, Xu S. Health improvement of the elderly in five Central Asian countries during COVID-19 based on difference game. PLoS One 2023; 18:e0294697. [PMID: 38051713 DOI: 10.1371/journal.pone.0294697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
In 2020, COVID-19 became a global pandemic. Older people are less resistant to the novel coronavirus. In order to ensure the health of the elderly population, the governments of five Central Asian countries should provide home medical services for the elderly or provide "green channel" to medical services. This "green channel" means providing a special service and treatment for the elderly in the hospital to ensure that they can safely and easily access the medical services they need. In order to study the application scope of various modes, this article constructs three modes of differential game: no special care, home medical care and "green channel". And the equilibrium results are compared and analyzed. Research shows that when the additional medical costs associated with house calls or "green channel" gradually increase, the social benefits to both the elderly and the government gradually decrease, and eventually it is less than the social benefits under the no-special care model. The greater the credibility of the government under the "green channel" service model, the greater the social benefits of the government. However, the greater the credibility of the government under the home medical service model, the smaller the social benefits of the government.
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Affiliation(s)
- Yuntao Bai
- Business School, Shandong Management University, Jinan, China
| | - Lan Wang
- Center of Emergency Management, Chongqing Academy of Governance, Chongqing, China
| | - Shuang Xu
- Business School, Shandong Management University, Jinan, China
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Russo A, Pisaturo M, Monari C, Ciminelli F, Maggi P, Allegorico E, Gentile I, Sangiovanni V, Esposito V, Gentile V, Calabria G, Pisapia R, Carriero C, Masullo A, Manzillo E, Russo G, Parrella R, Dell’Aquila G, Gambardella M, Ponticiello A, Onorato L, Coppola N. Prognostic Value of Creatinine Levels at Admission on Disease Progression and Mortality in Patients with COVID-19-An Observational Retrospective Study. Pathogens 2023; 12:973. [PMID: 37623933 PMCID: PMC10459783 DOI: 10.3390/pathogens12080973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/18/2023] [Accepted: 07/22/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Acute kidney disease and chronic kidney disease are considered conditions that can increase the mortality and severity of COVID-19. However, few studies have investigated the impact of creatinine levels on COVID-19 progression in patients without a history of chronic kidney disease. The aim of the study was to assess the impact of creatinine levels at hospital admission on COVID-19 progression and mortality. METHODS We performed a multicenter, observational, retrospective study involving seventeen COVID-19 Units in the Campania region in southern Italy. All adult (≥18 years) patients, hospitalized with a diagnosis of SARS-CoV-2 infection confirmed by a positive reverse transcriptase-polymerase chain reaction on a naso-oropharyngeal swab, from 28 February 2020 to 31 May 2021, were enrolled in the CoviCamp cohort. RESULTS Evaluating inclusion/exclusion criteria, 1357 patients were included. Considering in-hospital mortality and creatinine value at admission, the best cut-off point to discriminate a death during hospitalization was 1.115 mg/dL. The logistic regression demonstrated that factors independently associated with mortality were age (OR 1.082, CI: 1.054-1.110), Charlson Comorbidity Index (CCI) (OR 1.341, CI: 1.178-1.526), and an abnormal creatinine value at admission, defined as equal to or above 1.12 mg/dL (OR 2.233, CI: 1.373-3.634). DISCUSSION In conclusion, our study is in line with previous studies confirming that the creatinine serum level can predict mortality in COVID-19 patients and defining that the best cut-off of the creatinine serum level at admission to predict mortality was 1.12 mg/dL.
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Affiliation(s)
- Antonio Russo
- Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (M.P.); (C.M.); (F.C.); (L.O.)
| | - Mariantonietta Pisaturo
- Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (M.P.); (C.M.); (F.C.); (L.O.)
| | - Caterina Monari
- Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (M.P.); (C.M.); (F.C.); (L.O.)
| | - Federica Ciminelli
- Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (M.P.); (C.M.); (F.C.); (L.O.)
| | - Paolo Maggi
- Infectious Diseases Unit, A.O. S Anna e S Sebastiano Caserta, 81100 Caserta, Italy;
| | - Enrico Allegorico
- Emergency Unit, P.O. Santa Maria delle Grazie, 80078 Pozzuoli, Italy;
| | - Ivan Gentile
- Infectious Disease Unit, University Federico II, 80138 Naples, Italy;
| | - Vincenzo Sangiovanni
- Third Infectious Diseases Unit, AORN dei Colli, P.O. Cotugno, 80131 Naples, Italy;
| | - Vincenzo Esposito
- IV Infectious Disease Unit, AORN dei Coli, P.O. Cotugno, 80131 Naples, Italy;
| | - Valeria Gentile
- Hepatic Infectious Disease Unit, AORN dei Colli, P.O. Cotugno, 80131 Naples, Italy;
| | - Giosuele Calabria
- IX Infectious Disease Unit, AORN dei Coli, P.O. Cotugno, 80131 Naples, Italy;
| | - Raffaella Pisapia
- First Infectious Disease Unit, AORN dei Coli, P.O. Cotugno, 80131 Naples, Italy;
| | - Canio Carriero
- Department of Infectious Diseases, AORN S. Pio “G. Rummo” General Hospital, 82100 Benevento, Italy;
| | - Alfonso Masullo
- Infectious Disease Unit, A.O. San Giovanni di Dio e Ruggi D’Aragona Salerno, 84131 Salerno, Italy;
| | - Elio Manzillo
- VIII Infectious Disease Unit, AORN dei Coli, P.O. Cotugno, 80131 Naples, Italy;
| | - Grazia Russo
- Infectious Disease Unit, Ospedale Maria S.S. Addolorata di Eboli, ASL Salerno, 84025 Eboli, Italy;
| | - Roberto Parrella
- Respiratory Infectious Disease Unit, AORN dei Colli, P.O. Cotugno, 80131 Naples, Italy;
| | | | - Michele Gambardella
- Infectious Disease Unit, P.O. S. Luca, Vallo della Lucania, ASL Salerno, 84078 Salerno, Italy;
| | | | - Lorenzo Onorato
- Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (M.P.); (C.M.); (F.C.); (L.O.)
| | - Nicola Coppola
- Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (M.P.); (C.M.); (F.C.); (L.O.)
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Seethapathy R, Wang Q, Zhao S, Strohbehn IA, Long JD, Dinulos JE, Harden D, Kadiyala VB, Moreno D, Sise ME. Effect of remdesivir on adverse kidney outcomes in hospitalized patients with COVID-19 and impaired kidney function. PLoS One 2023; 18:e0279765. [PMID: 36848366 PMCID: PMC9970064 DOI: 10.1371/journal.pone.0279765] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 12/14/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is an important risk factor for mortality from COVID-19. Remdesivir has been shown to shorten time to recovery in patients with severe COVID-19. However, exclusion of patients with severe kidney function impairment in clinical trials has led to concerns about kidney safety of remdesivir in patients with pre-existing kidney disease. METHODS Retrospective propensity score matched cohort study of hospitalized patients with COVID-19 admitted with estimated glomerular filtration rate (eGFR) between 15 - 60 mL/min/1.73m2. Remdesivir-treated patients were 1:1 matched to historical comparators admitted during the first wave of COVID-19 (between March-April 2020) prior to emergency use authorization of remdesivir using propensity scores accounting for factors predicting treatment assignment. Dependent outcomes included in-hospital peak creatinine, incidence of doubling of creatine, rate of kidney replacement therapy initiation and eGFR among surviving patients at day 90. RESULTS 175 remdesivir-treated patients were 1:1 matched to untreated historical comparators. Mean age was 74.1 (SD 12.8), 56.9% were male, 59% patients were white, and the majority (83.1%) had at least one co-morbidity. There were no statistically significant differences in peak creatinine during hospitalization (2.3mg/dL vs. 2.5 mg/dL, P = 0.34), incidence of doubling of creatinine (10.3% vs. 13.1%, P = 0.48), and rate of kidney replacement therapy initiation (4.6% vs. 6.3%, P = 0.49) in remdesivir-treated patients versus matched untreated historical comparators, respectively. Among surviving patients, there was no difference of the average eGFR at day 90 (54.7 ± 20.0 mL/min/1.73m2 for remdesivir-treated patients vs. 51.7 ± 19.5 mL/min/1.73m2 for untreated comparators, P = 0.41). CONCLUSIONS Remdesivir use in patients with impaired kidney function (eGFR between 15 - 60 mL/min/1.73m2) who present to the hospital with COVID-19 is not associated with increased risk of adverse kidney outcomes.
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Affiliation(s)
- Rituvanthikaa Seethapathy
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Qiyu Wang
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Sophia Zhao
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Ian A. Strohbehn
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Joshua D. Long
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - James E. Dinulos
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Destiny Harden
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Vinay B. Kadiyala
- Department of Medicine, Mass General Brigham Salem Hospital, Salem, MA, United States of America
| | - Daiana Moreno
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Meghan E. Sise
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America,* E-mail:
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Lin L, Deng J, Tan W, Li J, Wu Z, Zheng L, Yang J. Pathogenesis and histological changes of nephropathy associated with COVID-19. J Med Virol 2023; 95:e28311. [PMID: 36377540 DOI: 10.1002/jmv.28311] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/01/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
Coronavirus disease 2019 (COVID-19) can cause damage to multiple organ, not only to the lungs, but also to the kidneys. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause acute and chronic kidney disease through direct viral infection, indirect injury, and vaccination-related injury. Like lung injury, kidney injury is also an important aspect affecting the severity and prognosis of SARS-CoV-2. This article summarizes the pathogenesis, pathological manifestations, and clinical features of SARS-CoV-2 direct or indirect renal injury. Including direct injury, indirect injury, special comorbidities (receiving kidney transplantation and chronic kidney disease), and vaccine-related renal injury, and exploring the possible therapeutic effect of anti-SARS-CoV-2 therapy on renal injury. The purpose is to provide reference for understanding COVID-19-related renal injury, guiding clinical and pathological diagnosis and treatment, and evaluating prognosis.
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Affiliation(s)
- Lirong Lin
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Junhui Deng
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Wei Tan
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Jie Li
- Department of Nephrology, Yongchuan People's Hospital of Chongqing, Chongqing, China
| | - Zhifeng Wu
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Luquan Zheng
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Jurong Yang
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
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Stancampiano F, Jhawar N, Alsafi W, Valery J, Harris D, Kempaiah P, Shah S, Heckman M, Siddiqui H, Libertin C. Use of remdesivir for COVID-19 pneumonia in patients with advanced kidney disease: A retrospective multicenter study. CLINICAL INFECTION IN PRACTICE 2022; 16:100207. [PMID: 36268055 PMCID: PMC9557110 DOI: 10.1016/j.clinpr.2022.100207] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/25/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background and objectives Remdesivir, an antiviral drug routinely used in the treatment of COVID-19 has not yet received FDA approval for use in patients with advanced kidney disease defined as GFR < 30 mL/min/1.73 m2. There is concern that an excipient in Veklury (Gilead's proprietary name for remdesivir) called sulfobutylether-beta-cyclodextrin (SBECD), which is renally cleared, may accumulate and reach toxic levels in patients with advanced kidney disease. The aim of this study was to summarize characteristics and incidence of adverse events of chronic kidney disease (CKD) patients who received remdesivir during hospitalization.Design, setting, participants, and measurements.We retrospectively studied patients admitted to one of several hospitals of the Mayo Clinic Foundation with the diagnosis of COVID-19 pneumonia and CKD. Laboratory values were also measured when remdesivir was first administered and stopped. All analyses were performed in the overall patient group and three separate subgroups of patients with a GFR ≥ 15, a GFR < 15 and dialysis, and a GFR < 15 and no dialysis. Results A total of 444 CKD patients who were admitted to the hospital with COVID-19 pneumonia between May 2020 and September 2021 were included. Information was collected on patient characteristics, hospitalization, and adverse events. In the overall cohort, median age was 72 years (Range: 21-100 years), 55.2 % of patients were male, and most (86.5 %) were Caucasian. CKD stage was 3 for 114 patients (25.7 %), 4 for 229 patients (51.6 %), and 5 for 101 patients (22.7 %). A total of 146 patients (32.9 %) were admitted to the ICU, 103 (23.2 %) died in the hospital, and 120 (27.0 %) were on dialysis. The proportion of patients with an adverse event did not differ dramatically between the GFR ≥ 15 (20.9 %), GFR < 15 and dialysis (30.2 %), and GFR < 15 and no dialysis (32.3 %) groups (P = 0.12). Conclusion Our results suggest that the use of remdesivir in patients with very severe CKD is safe, even in those who are not on renal replacement therapy.
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Affiliation(s)
- F. Stancampiano
- Department of Medicine, Mayo Clinic Florida, 4500 San Pablo Rd, 3-W Cannaday, Jacksonville, FL 32224, United States,Corresponding author
| | - N. Jhawar
- Department of Medicine, Mayo Clinic Florida, 4500 San Pablo Rd, 3-W Cannaday, Jacksonville, FL 32224, United States
| | - W. Alsafi
- Clinical Research Unit, Mayo Clinic Florida, 4500 San Pablo Rd, 3-W Cannaday, Jacksonville, FL 32224, United States
| | - J. Valery
- Department of Medicine, Mayo Clinic Florida, 4500 San Pablo Rd, 3-W Cannaday, Jacksonville, FL 32224, United States
| | - D.M. Harris
- Department of Medicine, Mayo Clinic Florida, 4500 San Pablo Rd, 3-W Cannaday, Jacksonville, FL 32224, United States
| | - P. Kempaiah
- Division of Infectious Disease, Mayo Clinic Florida, 4500 San Pablo Rd, Griffin 142, Jacksonville, FL 32224, United States
| | - S. Shah
- Division of Transplant Medicine and Critical Care, Mayo Clinic Florida, 4500 San Pablo Rd, Mayo 03, Jacksonville, FL 32224, United States
| | - M.G. Heckman
- Division of Clinical Trials and Biostatistics, Mayo Clinic Florida, 4500 San Pablo Rd, Stabile 750 N, Jacksonville, FL 32224, United States
| | - H. Siddiqui
- Division of Clinical Trials and Biostatistics, Mayo Clinic Florida, 4500 San Pablo Rd, Stabile 750 N, Jacksonville, FL 32224, United States
| | - C.R. Libertin
- Division of Infectious Disease, Mayo Clinic Florida, 4500 San Pablo Rd, Davis 408N, Jacksonville, FL 32224, United States
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Al Bishawi A, Abdel Hadi H, Elmekaty E, Al Samawi M, Nair A, Abou Kamar M, Al Maslamani M, Abdelmajid A. Remdesivir for COVID‐19 pneumonia in patients with severe chronic kidney disease: A Case series and review of the literature. Clin Case Rep 2022; 10:e05467. [PMID: 35228879 PMCID: PMC8867201 DOI: 10.1002/ccr3.5467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 12/30/2022] Open
Abstract
Remdesivir was the first antiviral agent to receive FDA authorization for severe COVID‐19 management, which restricts its use with severe renal impairment due to concerns that active metabolites might accumulate, causing renal toxicities. With limited treatment options, available evidence on such patient groups is important to assess for future safety. Our report suggests that Remdesivir is well tolerated and potentially safe among hospitalized patients with severe COVID‐19 infection with the background of advanced kidney diseases where benefits outweigh potential risks.
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Affiliation(s)
- Ahmad Al Bishawi
- Division of infectious Diseases Department of Internal Medicine Hamad Medical Corporation Doha Qatar
| | - Hamad Abdel Hadi
- Division of infectious Diseases Department of Internal Medicine Hamad Medical Corporation Doha Qatar
| | - Eman Elmekaty
- Division of infectious Diseases Department of Clinical Pharmacy Hamad Medical Corporation Doha Qatar
| | - Musaed Al Samawi
- Division of infectious Diseases Department of Internal Medicine Hamad Medical Corporation Doha Qatar
| | - Arun Nair
- Division of infectious Diseases Department of Internal Medicine Hamad Medical Corporation Doha Qatar
| | - Mohammed Abou Kamar
- Division of infectious Diseases Department of Internal Medicine Hamad Medical Corporation Doha Qatar
| | - Muna Al Maslamani
- Division of infectious Diseases Department of Internal Medicine Hamad Medical Corporation Doha Qatar
| | - Alaaeldin Abdelmajid
- Division of infectious Diseases Department of Internal Medicine Hamad Medical Corporation Doha Qatar
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Shumaker AH, Bhimraj A. PHARMACOLOGIC TREATMENT AND MANAGEMENT OF COVID-19. Infect Dis Clin North Am 2022; 36:349-364. [PMID: 35636904 PMCID: PMC8828431 DOI: 10.1016/j.idc.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Amy Hirsch Shumaker
- Clinical Pharmacy Specialist-Infectious Disease, Department of Pharmacy, VA Northeast Ohio Healthcare System, 10701 East Boulevard, Pharmacy 119 (W), Cleveland, OH 44106, USA; Senior Clinical Instructor, School of Medicine, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106-7341.
| | - Adarsh Bhimraj
- Section Head Neurologic Infectious Diseases, Department of Infectious Diseases, Cleveland Clinic, 9500 Euclid Avenue/g21, Cleveland, OH 44195, USA
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Seethapathy R, Zhao S, Long JD, Strohbehn IA, Sise ME. A Propensity Score-Matched Observational Study of Remdesivir in Patients with COVID-19 and Severe Kidney Disease. KIDNEY360 2021; 3:269-278. [PMID: 35373125 PMCID: PMC8967642 DOI: 10.34067/kid.0006152021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/03/2021] [Indexed: 01/10/2023]
Abstract
Background Remdesivir is not currently approved for patients with eGFR <30 ml/min per 1.73 m2. We aimed to determine the safety of remdesivir in patients with kidney failure. Methods This study was a retrospective cohort study of patients with COVID-19 hospitalized between May 2020 and January 2021 with eGFR <30 ml/min per 1.73 m2 who received remdesivir and historical controls with COVID-19 hospitalized between March 1, 2020 and April 30, 2020 prior to the emergency use authorization of remdesivir within a large health care system. Patients were 1:1 matched by propensity scores accounting for factors associated with treatment assignment. Adverse events and hospital outcomes were recorded by manual chart review. Results The overall cohort included 34 hospitalized patients who initiated remdesivir within 72 hours of hospital admission with eGFR<30 ml/min per 1.73 m2 and 217 COVID-19 controls with eGFR <30 ml/min per 1.73 m2. The propensity score-matched cohort included 31 remdesivir-treated patients and 31 nonremdesivir-treated controls. The mean age was 74.0 (SD=13.8) years, 57% were women, and 68% were white participants. A total of 26% had ESKD. Among patients who were not on dialysis prior to initiating remdesivir, one developed worsening kidney function (defined as ≥50% increase in creatinine or initiation of KRT) compared with three in the historical control group. There was no increased risk of cardiac arrythmia, cardiac arrest, altered mental status, or clinically significant anemia or liver function test abnormalities. There was a significantly increased risk of hyperglycemia, which may be partly explained by the increased use of dexamethasone in the remdesivir-treated population. Conclusions In this propensity score-matched study, remdesivir was well tolerated in patients with eGFR <30 ml/min per 1.73 m2.
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Affiliation(s)
- Rituvanthikaa Seethapathy
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sophia Zhao
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | - Joshua D. Long
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ian A. Strohbehn
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | - Meghan E. Sise
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
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