1
|
Zafarbakhsh A, Vaezi A, Haghjooy Javanmard S, Sabet F, Dehghan M. Remdesivir Prescription in Pregnant Women Infected with COVID-19: A Report of Compassionate Use. Adv Biomed Res 2023; 12:163. [PMID: 37564441 PMCID: PMC10410426 DOI: 10.4103/abr.abr_142_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 08/12/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is an infectious disease that the physiological changes in pregnancy can make pregnant patients more susceptible to more severe forms of this infection. Hence, the treatment of COVID-19 in pregnant women can be challenging. This study was designed to evaluate the safety and efficacy of Remdesivir in pregnant women with COVID-19. Materials and Methods This study was conducted on 150 pregnant women with moderate to severe COVID-19 infection. Remdesivir was prescribed and continued for 5 or 10 days according to the patient's condition. Maternal and pregnancy outcomes and also recovery rates were evaluated. Moreover, additional variables were examined: age, gestational age, symptoms, O2 saturation and laboratory tests at admission, the interval between symptom initiation and admission to hospital and Remdesivir prescription, hospitalization days, and ICU admission. Results The mean age was 32.37 years. Cough and dyspnea were the most prevalent symptoms (74% and 68.7%, respectively). At the time of admission, 79 (52.7%) women needed low-flow oxygen support, 67 (44.7%) needed high-flow oxygen support, and 4 (2.7%) were intubated. Fifty-four (36%) patients required ICU care. In patients who died (12 women), Remdesivir was prescribed later than those discharged (P value, 0.04). Patients with favorable pregnancy outcomes received Remdesivir earlier than those with unfavorable pregnancy outcomes (P value: 0.008). The recovery rate was 70% (89.9% in the low-flow oxygen, 50.7% in the NIPPV/high flow oxygen, and 0% in the intubated women). Conclusion The results suggest that the early prescription of Remdesivir in pregnant women with moderate COVID-19 can improve the outcomes.
Collapse
Affiliation(s)
- Azam Zafarbakhsh
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atefeh Vaezi
- Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shaghayegh Haghjooy Javanmard
- Department of Physiology, School of Medicine, Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Sabet
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Dehghan
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
2
|
Kirkwood‐Johnson L, Marikawa Y. Developmental toxicity of remdesivir, an anti-COVID-19 drug, is implicated by in vitro assays using morphogenetic embryoid bodies of mouse and human pluripotent stem cells. Birth Defects Res 2023; 115:224-239. [PMID: 36349436 PMCID: PMC9877128 DOI: 10.1002/bdr2.2111] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/09/2022] [Accepted: 10/14/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Remdesivir is an antiviral drug approved for the treatment of COVID-19, whose developmental toxicity remains unclear. More information about the safety of remdesivir is urgently needed for people of childbearing potential, who are affected by the ongoing pandemic. Morphogenetic embryoid bodies (MEBs) are three-dimensional (3D) aggregates of pluripotent stem cells that recapitulate embryonic body patterning in vitro, and have been used as effective embryo models to detect the developmental toxicity of chemical exposures specifically and sensitively. METHODS MEBs were generated from mouse P19C5 and human H9 pluripotent stem cells, and used to examine the effects of remdesivir. The morphological effects were assessed by analyzing the morphometric parameters of MEBs after exposure to varying concentrations of remdesivir. The molecular impact of remdesivir was evaluated by measuring the transcript levels of developmental regulator genes. RESULTS The mouse MEB morphogenesis was impaired by remdesivir at 1-8 μM. Remdesivir affected MEBs in a manner dependent on metabolic conversion, and its potency was higher than GS-441524 and GS-621763, presumptive anti-COVID-19 drugs that act similarly to remdesivir. The expressions of developmental regulator genes, particularly those involved in axial and somite patterning, were dysregulated by remdesivir. The early stage of MEB development was more vulnerable to remdesivir exposure than the later stage. The morphogenesis and gene expression profiles of human MEBs were also impaired by remdesivir at 1-8 μM. CONCLUSIONS Remdesivir impaired mouse and human MEBs at concentrations that are comparable to the therapeutic plasma levels in humans, urging further investigation into the potential impact of remdesivir on developing embryos.
Collapse
Affiliation(s)
- Lauren Kirkwood‐Johnson
- Developmental and Reproductive Biology Graduate Program, Institute for Biogenesis Research, Department of Anatomy, Biochemistry and PhysiologyJohn A. Burns School of Medicine, University of Hawaii at ManoaHonoluluHawaiiUSA
| | - Yusuke Marikawa
- Developmental and Reproductive Biology Graduate Program, Institute for Biogenesis Research, Department of Anatomy, Biochemistry and PhysiologyJohn A. Burns School of Medicine, University of Hawaii at ManoaHonoluluHawaiiUSA
| |
Collapse
|
3
|
Lam V, Hu KM. Management of COVID-19 Infection in Pregnancy. Emerg Med Clin North Am 2022; 41:307-322. [PMID: 37024166 PMCID: PMC9755010 DOI: 10.1016/j.emc.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Although the majority of pregnant patients who contract severe acute respiratory syndrome coronavirus 2 will have a mild course of illness, pregnant patients with coronavirus disease-2019 are more likely than their nonpregnant counterparts to develop a severe illness with an increased risk of poor maternal and fetal outcomes. Although the extent of research in this specific patient population remains limited, there are tenets of care with which physicians and other providers must be familiar to increase the chances of better outcomes for the two patients in their care.
Collapse
Affiliation(s)
- Vivian Lam
- Department of Internal Medicine, Section of Critical Care Medicine, Advocate Christ Medical Center, 4440 West 95th Street, Suite AIP, Oak Lawn, IL 60453, USA
| | - Kami M Hu
- Department of Internal Medicine, Section of Critical Care Medicine, Advocate Christ Medical Center, 4440 West 95th Street, Suite AIP, Oak Lawn, IL 60453, USA; Division of Pulmonary & Critical Care, Department of Internal Medicine, University of Maryland, School of Medicine, 110 South Paca Street, 6th Floor Suite 200, Baltimore, MD 21201, USA.
| |
Collapse
|
4
|
Sánchez-García JC, Carrascosa Moreno NP, Tovar-Gálvez MI, Cortés-Martín J, Liñán-González A, Alvarado Olmedo L, Rodríguez-Blanque R. COVID-19 in Pregnant Women, Maternal-Fetal Involvement, and Vertical Mother-to-Child Transmission: A Systematic Review. Biomedicines 2022; 10:biomedicines10102554. [PMID: 36289816 PMCID: PMC9599127 DOI: 10.3390/biomedicines10102554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/22/2022] [Accepted: 10/09/2022] [Indexed: 11/16/2022] Open
Abstract
Pregnant women are included in the COVID-19 risk groups even if they do not have any pathology. This requires an analysis of research focused on pregnant women to understand the impact of SARS-CoV-2 on their condition. There is also a need to know whether there is vertical mother-to-child transmission, as well as other consequences in case the pregnant woman is infected and COVID-19 positive. A systematic review was carried out to analyze the existing information on the complications of a pregnant woman infected with the SARS-CoV-2 coronavirus and the possibility of vertical transmission from mother to child, registered in the PROSPERO website and searched in the PubMed, Scopus, CINAHL, and Cochrane Library databases. Finally, 22 articles were included in the review. The review suggests that vertical transmission from mother to child could be exceptionally possible at the time of delivery or breastfeeding, but not through the placenta. It is interesting to point out the good acceptance of vaccination by pregnant women, which may be the reason for the low infectivity. Further research on pregnant women should be carried out to provide evidence on vertical mother-to-child transmission and the role of breast milk in relation to SARS-CoV-2.
Collapse
Affiliation(s)
- Juan Carlos Sánchez-García
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 41006 Sevilla, Spain
- Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
| | | | - María Isabel Tovar-Gálvez
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 41006 Sevilla, Spain
- Nursing Department, Faculty of Health Sciences in Ceuta, University of Granada, 51001 Ceuta, Spain
- Correspondence:
| | - Jonathan Cortés-Martín
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 41006 Sevilla, Spain
- Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
| | - Antonio Liñán-González
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 41006 Sevilla, Spain
- Nursing Department, Faculty of Health Sciences in Melilla, University of Granada, Melilla Campus, 52005 Melilla, Spain
| | - Leticia Alvarado Olmedo
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 41006 Sevilla, Spain
- Nursing Department, Faculty of Health Sciences in Ceuta, University of Granada, 51001 Ceuta, Spain
| | - Raquel Rodríguez-Blanque
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, 41006 Sevilla, Spain
- Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
| |
Collapse
|
5
|
Buonomo AR, Esposito N, Di Filippo I, Saccone G, Pinchera B, Scotto R, Bifulco G, Gentile I. Safety and efficacy of monoclonal antibodies anti SARS-CoV-2 in pregnancy. Expert Opin Drug Saf 2022; 21:1137-1141. [PMID: 36082789 DOI: 10.1080/14740338.2022.2122436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND SARS CoV-2 infection in pregnant women has become an urgent medical concern since it has been demonstrated a high rate of severe course of COVID-19, with evidence of increased mortality and peri-partum complications, especially when the infect.
Collapse
Affiliation(s)
- Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
| | - Nunzia Esposito
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
| | - Isabella Di Filippo
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Science and Dentistry, School of Medicine, University of Naples Federico II - Naples Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
| | - Giuseppe Bifulco
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
| |
Collapse
|
6
|
Chatterjee B, Thakur SS. Remdesivir and Its Combination With Repurposed Drugs as COVID-19 Therapeutics. Front Immunol 2022; 13:830990. [PMID: 35634324 PMCID: PMC9134007 DOI: 10.3389/fimmu.2022.830990] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/05/2022] [Indexed: 01/18/2023] Open
Abstract
The SARS-CoV-2 virus needs multiple copies for its multiplication using an enzyme RNA-dependent RNA polymerase (RdRp). Remdesivir inhibits viral RdRp, controls the multiplication of the virus, and protects patients. However, treatment of COVID-19 with remdesivir involves adverse effects. Many ongoing clinical trials are exploring the potential of the combination of remdesivir with repurposed drugs by targeting multiple targets of virus and host human simultaneously. Better results were obtained with the remdesivir–baricitinib combination treatment for COVID-19 compared to the treatment with remdesivir alone. Notably, recovery from COVID-19 was found to be 8 days less via the remdesivir–baricitinib combination treatment as compared to remdesivir treatment alone. Furthermore, the mortality rate via the remdesivir–baricitinib combination treatment was lower compared to the remdesivir-only treatment. Remdesivir targets the SARS-CoV-2 enzyme while baricitinib targets the host human enzyme. Simultaneously, remdesivir and baricitinib as a combination inhibit their target viral RdRp and human Janus kinase, respectively. Ongoing trials for the combination of drugs will suggest in the future whether they may reduce the recovery time, reduce the mortality rate, and improve patient clinical status for noninvasive ventilation. In the future, simultaneously targeting virus replication enzymes and host human kinases may be the strategy for SARS-CoV-2 therapeutics.
Collapse
Affiliation(s)
- Bhaswati Chatterjee
- Chemical Science, National Institute of Pharmaceutical Education and Research, Hyderabad, India
- *Correspondence: Bhaswati Chatterjee, ; Suman S. Thakur,
| | - Suman S. Thakur
- Proteomics and Cell Signaling, Centre for Cellular and Molecular Biology, Hyderabad, India
- *Correspondence: Bhaswati Chatterjee, ; Suman S. Thakur,
| |
Collapse
|
7
|
Giorgini C, Simonte R, Cammarota G, DE Robertis E. What's new on the management of obstetric patients who tested positive for Covid-19? Minerva Anestesiol 2022; 88:516-523. [PMID: 35199974 DOI: 10.23736/s0375-9393.22.16283-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To date, there is still partial data on the effects of COVID-19 on pregnant women. The constant collection of information results in a continuous updating of the knowledge about the best management of pregnant patients affected by COVID-19. This work aims to summarize the state of the art on prevention and management of SARSCoV-2 infection in obstetric patients. This was enabled by a comprehensive literature search for the most recent and relevant publications on the subject, including guidelines and recommendations. Management of these women by a multidisciplinary team is of crucial importance, given the extreme clinical complexity of this condition. Every health worker involved must put in place all possible procedures to protect themselves from contagion. Neuraxial anesthesia should be favored in the management of labor and caesarean section over other modalities, unless there are contraindications based on the patient's status. There is still no standardized drug treatment in pregnant women with COVID-19 due to their exclusion from studies conducted to evaluate pharmacological therapies. Nevertheless, various drugs have been used to treat this disease in pregnancy, although the data at our disposal are still few. As regards mRNA vaccines, it seems that their immunogenicity, safety and tolerability in pregnant women are comparable to those of non-pregnant women of the same age. More studies are certainly needed in infected pregnant women to establish treatment and prevention protocols for this special category of patients.
Collapse
Affiliation(s)
- Carla Giorgini
- Division of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, Hospital S. Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Rachele Simonte
- Division of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, Hospital S. Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Gianmaria Cammarota
- Division of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, Hospital S. Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Edoardo DE Robertis
- Division of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, Hospital S. Maria della Misericordia, University of Perugia, Perugia, Italy -
| |
Collapse
|
8
|
Budi DS, Pratama NR, Wafa IA, Putra M, Wardhana MP, Wungu CDK. Remdesivir for pregnancy: A systematic review of antiviral therapy for COVID-19. Heliyon 2022; 8:e08835. [PMID: 35128114 PMCID: PMC8802673 DOI: 10.1016/j.heliyon.2022.e08835] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/26/2021] [Accepted: 01/24/2022] [Indexed: 12/15/2022] Open
Abstract
Objective The use of remdesivir for pregnant patients with coronavirus disease 2019 (COVID-19) showed conflicting results in prior studies. We aimed to systematically review its efficacy and safety for this population from the existing literature. Methods On July 26, 2021, registries (ClinicalTrials.gov) and databases (MEDLINE, ScienceDirect, Cochrane Library, JSTOR, DOAJ, and medRxiv) were systematically searched for research articles investigating remdesivir use in pregnant people with COVID-19. Clinical outcome, hospitalization duration, laboratory outcome, mortality, and adverse events were investigated. Results We obtained 13 observation studies with 113 pregnant people. In these studies, remdesivir improved the clinical condition of pregnant patients with COVID-19, especially those who had a better clinical status at baseline and received earlier remdesivir treatment. Most fetuses were delivered via cesarean section, primarily because of emergency causes. No vertical transmissions were noted. The most reported adverse event was transaminitis, in which 10-day remdesivir treatment yielded more incidence than the 5-day treatment. Conclusions In pregnancy, the use of Remdesivir in combination with other COVID-19 treatments is inconclusive but its use should be followed with careful monitoring of adverse reactions and transaminase enzyme levels. Further studies are required to confirm its finding.
Collapse
Affiliation(s)
| | | | - Ifan Ali Wafa
- Faculty of Medicine, Universitas Airlangga, Indonesia
| | - Manesha Putra
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz School of Medicine, Aurora, United States
| | - Manggala Pasca Wardhana
- Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Dr. Soetomo Hospital, Faculty of Medicine of Universitas Airlangga, Surabaya, Indonesia
| | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Indonesia.,Institute of Tropical Disease, Universitas Airlangga, Indonesia
| |
Collapse
|