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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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Yan Y, Li J, Jiao Z, Yang M, Li L, Wang G, Chen Y, Li M, Shen Z, Shi Y, Peng G. Better therapeutic effect of oral administration of GS441524 compared with GC376. Vet Microbiol 2023; 283:109781. [PMID: 37269714 DOI: 10.1016/j.vetmic.2023.109781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 06/05/2023]
Abstract
FIP is a fatal feline disease caused by FIPV. Two drugs (GS441524 and GC376) target FIPV and have good therapeutic effect when administered by subcutaneous injection. However, subcutaneous injection has limitations compared with oral administration. Additionally, the oral efficacy of the two drugs has not been determined. Here, GS441524 and GC376 were shown to efficiently inhibit FIPV-rQS79 (recombination virus with a full-length field type I FIPV and the spike gene replaced with type II FIPV) and FIPV II (commercially available type II FIPV 79-1146) at a noncytotoxic concentration in CRFK cells. Moreover, the effective oral dose was determined via the in vivo pharmacokinetics of GS441524 and GC376. We conducted animal trials in three dosing groups and found that while GS441524 can effectively reducing the mortality of FIP subjects at a range of doses, GC376 only reducing the mortality rate at high doses. Additionally, compared with GC376, oral GS441524 has better absorption, slower clearance and a slower rate of metabolism. Furthermore, there was no significant difference between the oral and subcutaneous pharmacokinetic parameters. Collectively, our study is the first to evaluate the efficacy of oral GS441524 and GC376 using a relevant animal model. We also verified the reliability of oral GS441524 and the potential of oral GC376 as a reference for rational clinical drug use. Furthermore, the pharmacokinetic data provide insights into and potential directions for the optimization of these drugs.
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Affiliation(s)
- Yuanyuan Yan
- State Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China; Key Laboratory of Preventive Veterinary Medicine in Hubei Province, The Cooperative Innovation Center for Sustainable Pig Production, Wuhan, China
| | - Jia Li
- State Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China; Key Laboratory of Preventive Veterinary Medicine in Hubei Province, The Cooperative Innovation Center for Sustainable Pig Production, Wuhan, China
| | - Zhe Jiao
- State Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China; Key Laboratory of Preventive Veterinary Medicine in Hubei Province, The Cooperative Innovation Center for Sustainable Pig Production, Wuhan, China
| | - Mengfang Yang
- State Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China; Key Laboratory of Preventive Veterinary Medicine in Hubei Province, The Cooperative Innovation Center for Sustainable Pig Production, Wuhan, China
| | - Lisha Li
- State Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China; Key Laboratory of Preventive Veterinary Medicine in Hubei Province, The Cooperative Innovation Center for Sustainable Pig Production, Wuhan, China
| | - Gang Wang
- State Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China; Key Laboratory of Preventive Veterinary Medicine in Hubei Province, The Cooperative Innovation Center for Sustainable Pig Production, Wuhan, China
| | - Yixi Chen
- State Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China; Key Laboratory of Preventive Veterinary Medicine in Hubei Province, The Cooperative Innovation Center for Sustainable Pig Production, Wuhan, China
| | - Mengxia Li
- State Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China; Key Laboratory of Preventive Veterinary Medicine in Hubei Province, The Cooperative Innovation Center for Sustainable Pig Production, Wuhan, China
| | - Zhou Shen
- State Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China; Key Laboratory of Preventive Veterinary Medicine in Hubei Province, The Cooperative Innovation Center for Sustainable Pig Production, Wuhan, China
| | - Yuejun Shi
- State Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China; Key Laboratory of Preventive Veterinary Medicine in Hubei Province, The Cooperative Innovation Center for Sustainable Pig Production, Wuhan, China
| | - Guiqing Peng
- State Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China; Key Laboratory of Preventive Veterinary Medicine in Hubei Province, The Cooperative Innovation Center for Sustainable Pig Production, Wuhan, China.
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Remdesivir Administration in COVID-19 Patients With Renal Impairment: A Systematic Review. Am J Ther 2022; 29:e520-e533. [PMID: 35984955 DOI: 10.1097/mjt.0000000000001543] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Remdesivir (RDV) is the main antiviral for the treatment of moderate to severe forms of Coronavirus disease 2019 (COVID-19). Several studies revealed a shortening time to clinical improvement of COVID-19 and mortality benefits in patients receiving RDV. The patients with renal disease were excluded from large clinical trials of RDV, and the probable nephrotoxicity of the drug, its metabolites, and the vehicle (sulfobutylether-β-cyclodextrin) have led to the recommendation against using RDV in patients with an estimated glomerular filtration rate of <30 mL/min. AREAS OF UNCERTAINTY This systematic review aimed to collect data about the necessity and safety administration of RDV in the setting of renal impairment. DATA SOURCES Search through databases including MEDLINE, ScienceDirect, Cochrane Library, and PubMed was performed. The studies were carried out in adults and enrolled patients with different types of renal impairment (ie, acute kidney injury, chronic kidney disease, kidney transplant, and renal replacement therapy) were included. Eligible studies were assessed, and required data were extracted. RESULTS Twenty-two cross-sectional studies, cohorts, case reports, and case series were included in this review. The mortality rate was between 7.3% and 50%, and various severity of COVID-19 was included in the studies. None of them reported an increase in adverse effects attributed to RDV administration. A decrease in inflammatory mediators and other benefits were obvious. CONCLUSIONS Although the manufacturer's labeling does not recommend RDV administration in patients with severe renal impairment, it seems that nephrotoxicity is less concerning in the population of these patients. Moreover, RDV may be helpful in acute kidney injury induced by the viral invasion of COVID-19. To the best of our knowledge, this is the first systematic review of the use of RDV in kidney failure. Larger, well-designed, and pharmacokinetic studies are required to have a safe and logical recommendation about the use of RDV in patients with renal disorders.
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Osmotic Tubulopathy and Acute Thrombotic Microangiopathy in a Kidney Transplant Recipient With a Breakthrough COVID-19 Infection. Kidney Med 2022; 4:100492. [PMID: 35637695 PMCID: PMC9134749 DOI: 10.1016/j.xkme.2022.100492] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Li Y, Cao L, Li G, Cong F, Li Y, Sun J, Luo Y, Chen G, Li G, Wang P, Xing F, Ji Y, Zhao J, Zhang Y, Guo D, Zhang X. Remdesivir Metabolite GS-441524 Effectively Inhibits SARS-CoV-2 Infection in Mouse Models. J Med Chem 2022; 65:2785-2793. [PMID: 33523654 PMCID: PMC7875336 DOI: 10.1021/acs.jmedchem.0c01929] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Indexed: 12/12/2022]
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) has resulted in a global pandemic due to the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). At the time of this manuscript's publication, remdesivir is the only COVID-19 treatment approved by the United States Food and Drug Administration. However, its effectiveness is still under question due to the results of the large Solidarity Trial conducted by the World Health Organization. Herein, we report that the parent nucleoside of remdesivir, GS-441524, potently inhibits the replication of SARS-CoV-2 in Vero E6 and other cell lines. Challenge studies in both an AAV-hACE2 mouse model of SARS-CoV-2 and in mice infected with murine hepatitis virus, a closely related coronavirus, showed that GS-441524 was highly efficacious in reducing the viral titers in CoV-infected organs without notable toxicity. Our results support that GS-441524 is a promising and inexpensive drug candidate for treating of COVID-19 and other CoV diseases.
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Affiliation(s)
- Yingjun Li
- Shenzhen Key Laboratory of Small
Molecule Drug Discovery and Synthesis, Department of Chemistry,
College of Science, Southern University of Science and
Technology, Shenzhen, Guangdong 518055,
China
- Medi-X, Academy for Advanced
Interdisciplinary Studies, Southern University of Science
and Technology, Shenzhen, Guangdong 518055,
China
| | - Liu Cao
- Centre for Infection and Immunity
Studies, School of Medicine, Sun Yat-sen
University, Shenzhen, Guangdong 518107,
China
| | - Ge Li
- Guangdong Province Key Laboratory of
Laboratory Animals, Guangdong Laboratory Animals
Monitoring Institute, Guangzhou, Guangdong 510663,
China
| | - Feng Cong
- Guangdong Province Key Laboratory of
Laboratory Animals, Guangdong Laboratory Animals
Monitoring Institute, Guangzhou, Guangdong 510663,
China
| | - Yunfeng Li
- Guangdong Province Key Laboratory of
Laboratory Animals, Guangdong Laboratory Animals
Monitoring Institute, Guangzhou, Guangdong 510663,
China
| | - Jing Sun
- State Key Laboratory of Respiratory
Disease, National Clinical Research Center for Respiratory Disease,
Guangzhou Institute of Respiratory Health, The First
Affiliated Hospital of Guangzhou Medical
University, Guangzhou, Guangdong 510182,
China
| | - Yinzhu Luo
- Guangdong Province Key Laboratory of
Laboratory Animals, Guangdong Laboratory Animals
Monitoring Institute, Guangzhou, Guangdong 510663,
China
| | - Guijiang Chen
- Guangdong Province Key Laboratory of
Laboratory Animals, Guangdong Laboratory Animals
Monitoring Institute, Guangzhou, Guangdong 510663,
China
| | - Guanguan Li
- Shenzhen Key Laboratory of Small
Molecule Drug Discovery and Synthesis, Department of Chemistry,
College of Science, Southern University of Science and
Technology, Shenzhen, Guangdong 518055,
China
| | - Ping Wang
- Shenzhen Key Laboratory of Small
Molecule Drug Discovery and Synthesis, Department of Chemistry,
College of Science, Southern University of Science and
Technology, Shenzhen, Guangdong 518055,
China
| | - Fan Xing
- Centre for Infection and Immunity
Studies, School of Medicine, Sun Yat-sen
University, Shenzhen, Guangdong 518107,
China
| | - Yanxi Ji
- Centre for Infection and Immunity
Studies, School of Medicine, Sun Yat-sen
University, Shenzhen, Guangdong 518107,
China
| | - Jincun Zhao
- State Key Laboratory of Respiratory
Disease, National Clinical Research Center for Respiratory Disease,
Guangzhou Institute of Respiratory Health, The First
Affiliated Hospital of Guangzhou Medical
University, Guangzhou, Guangdong 510182,
China
| | - Yu Zhang
- Guangdong Province Key Laboratory of
Laboratory Animals, Guangdong Laboratory Animals
Monitoring Institute, Guangzhou, Guangdong 510663,
China
| | - Deyin Guo
- Centre for Infection and Immunity
Studies, School of Medicine, Sun Yat-sen
University, Shenzhen, Guangdong 518107,
China
| | - Xumu Zhang
- Shenzhen Key Laboratory of Small
Molecule Drug Discovery and Synthesis, Department of Chemistry,
College of Science, Southern University of Science and
Technology, Shenzhen, Guangdong 518055,
China
- Medi-X, Academy for Advanced
Interdisciplinary Studies, Southern University of Science
and Technology, Shenzhen, Guangdong 518055,
China
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Selvaraj V, Lal A, Finn A, Tanzer JR, Baig M, Jindal A, Dapaah-Afriyie K, Bayliss G. Efficacy of remdesivir for hospitalized COVID-19 patients with end stage renal disease. World J Crit Care Med 2022; 11:48-57. [PMID: 35433306 PMCID: PMC8788204 DOI: 10.5492/wjccm.v11.i1.48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/04/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Since the beginning of corona virus disease 2019 (COVID-19) pandemic, there has been a widespread use of remdesivir in adults and children. There is little known information about its outcomes in patients with end stage renal disease who are on dialysis.
AIM To assess the clinical outcomes with use of remdesivir in adult patients with end stage kidney failure on hemodialysis.
METHODS A retrospective, multicenter study was conducted on patients with end stage renal disease on hemodialysis that were discharged after treatment for COVID-19 between April 1, 2020 and December 31, 2020. Primary endpoints were oxygen requirements, time to mortality and escalation of care needing mechanical ventilation.
RESULTS A total of 45 patients were included in the study. Twenty patients received remdesivir, and 25 patients did not receive remdesivir. Most patients were caucasian, females with diabetes mellitus and hypertension being the commonest comorbidities. There was a trend towards reduced oxygen requirement (beta = -25.93, X2 (1) = 6.65, P = 0.0099, probability of requiring mechanical ventilation (beta = -28.52, X2 (1) = 22.98, P < 0.0001) and mortality (beta = -5.03, X2 (1) = 7.41, P = 0.0065) in patients that received remdesivir compared to the control group.
CONCLUSION Larger studies are justified to study the effects of remdesivir in this high-risk population with end stage kidney disease on dialysis.
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Affiliation(s)
- Vijairam Selvaraj
- Department of Medicine, Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - Amos Lal
- Department of Medicine, Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN 55905, United States
| | - Arkadiy Finn
- Department of Medicine, Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - Joshua Ray Tanzer
- Department of Biostatistics Core, Lifespan Group, Providence, RI 02906, United States
| | - Muhammad Baig
- Department of Medicine, Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - Atin Jindal
- Department of Medicine, Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - Kwame Dapaah-Afriyie
- Department of Medicine, Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - George Bayliss
- Department of Medicine, Rhode Island Hospital and Alpert Medical School, Bayliss, Division of Kidney and Hypertension, Brown University, Providence, RI 02906, United States
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Choe PG, Jeong SI, Kang CK, Yang L, Lee S, Cho JY, Han SS, Kim DK, Lee SM, Park WB, Oh MD, Kim NJ. Exploration for the effect of renal function and renal replacement therapy on pharmacokinetics of remdesivir and GS-441524 in patients with COVID-19: A limited case series. Clin Transl Sci 2021; 15:732-740. [PMID: 34761554 PMCID: PMC8652615 DOI: 10.1111/cts.13194] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/26/2021] [Accepted: 10/31/2021] [Indexed: 11/28/2022] Open
Abstract
Remdesivir, an antiviral agent for the treatment of coronavirus disease 2019 (COVID‐19), is metabolized intracellularly, with these metabolites eliminated predominantly in urine. Because of a lack of safety and pharmacokinetic (PK) data, remdesivir is not currently recommended for patients with estimated glomerular filtration rate less than 30 ml/min/1.73 m2 and those on hemodialysis. This study evaluated the PKs of remdesivir and its metabolite, GS‐441524, in patients with COVID‐19 who were and were not receiving renal replacement therapy (RRT). This study enrolled two patients with normal renal function, two with impaired renal function not receiving RRT, two receiving continuous RRT (CRRT), and three undergoing intermittent hemodialysis (IHD). Patients were administered 200 mg remdesivir on the first day, followed by 100 mg/day for 5–10 days. Serial blood samples were collected for PK analysis, and PK parameters were assessed by a noncompartmental method. Systemic exposure to remdesivir was higher in patients with impaired renal function and those receiving CRRT than in patients with normal renal function, but was similar in patients undergoing IHD and those with normal renal function. By contrast, systemic exposure to GS‐441524 was highest in patients undergoing IHD, followed by patients with impaired renal function and those receiving CRRT, and lowest in patients with normal renal function. The PK profiles of remdesivir and GS‐441524 varied according to renal function and RRT. The impact of PK changes of remdesivir and its metabolite on safety and efficacy should be considered when administering remdesivir to patients with COVID‐19 with renal impairment.
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Affiliation(s)
- Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Sae Im Jeong
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Liju Yang
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - SeungHwan Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Joo-Youn Cho
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Sang Min Lee
- Department of Internal Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
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Mechineni A, Kassab H, Manickam R. Remdesivir for the treatment of COVID 19: review of the pharmacological properties, safety and clinical effectiveness. Expert Opin Drug Saf 2021; 20:1299-1307. [PMID: 34338121 DOI: 10.1080/14740338.2021.1962284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Remdesivir is a nucleoside analog that inhibits viral RNA replication by blocking RNA-dependent RNA polymerase. First developed and tested during the Ebola epidemic, repurposed, and gained prominence during the Coronavirus disease 19 (COVID-19) pandemic. Based on data from three major trials, remdesivir became the first and only medication to obtain approval from the Food and Drug Administration (FDA) to treat patients hospitalized with COVID-19 disease. AREAS COVERED The purpose of the article is to review available preclinical, clinical, and post-marketing data to assess the safety and efficacy of remdesivir in the treatment of COVID-19 patients. We performed a comprehensive literature review of articles published on remdesivir until January 2021. EXPERT OPINION The substantial evidence of its effectiveness in a few trials together with the favorable safety profile makes remdesivir a primary therapeutic candidate for treatment in adult and pediatric patients who are hospitalized with COVID-19 and requiring oxygen supplementation. While remdesivir does not improve mortality, it has been shown to reduce the recovery time and increase the odds for clinical improvement, specifically in patients with early presentation and moderate COVID-19 disease. Remdesivir is well tolerated and has an acceptable safety profile in the pediatric and adult populations.
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Affiliation(s)
- Ashesha Mechineni
- Department of Pulmonary and Critical Care Medicine,St.Joseph'University Medical Center,Paterson, NJ, USA
| | - Hagar Kassab
- Department of Internal Medicine, St Joseph University Medical Center, Paterson, NJ, USA
| | - Rajapriya Manickam
- Department of Pharmacy, St Joseph University Medical Center, Paterson, NJ, USA
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Schieber TJ, Bennett N, Aragon L, Ploetz J, Boyd S. Real-world risk evaluation of remdesivir in patients with an estimated glomerular filtration rate of less than 30 mL/min. Am J Health Syst Pharm 2021; 78:2101-2102. [PMID: 34107027 PMCID: PMC8344606 DOI: 10.1093/ajhp/zxab245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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Affiliation(s)
- Timothy J Schieber
- School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO.,Department of Pharmacy, Saint Luke's Health System, Kansas City, MO, USA
| | - Nicholas Bennett
- Antimicrobial and Diagnostic Advisement Program, Saint Luke's Health System, Kansas City, MO, USA
| | - Laura Aragon
- Antimicrobial and Diagnostic Advisement Program, Saint Luke's Health System, Kansas City, MO, USA
| | - Jeannette Ploetz
- Department of Pharmacy, Saint Luke's Health System, Kansas City, MO, USA
| | - Sarah Boyd
- Antimicrobial and Diagnostic Advisement Program, Saint Luke's Health System, Kansas City, MO, USA.,Division of Infectious Disease, Department of Medicine, Saint Luke's Health System, Kansas City, MO, USA
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Plasma concentrations of remdesivir metabolite in a critical COVID-19 patient needing continuous venovenous haemodialysis. Eur J Clin Pharmacol 2021; 77:1583-1585. [PMID: 33982133 PMCID: PMC8116063 DOI: 10.1007/s00228-021-03128-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022]
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Kusztal M, Myślak M. Therapeutic dilemmas in dialysis patients hospitalized for COVID-19: balancing between nihilism, off-label treatment and side effects. Clin Kidney J 2021; 14:1039-1041. [PMID: 33841852 PMCID: PMC7929032 DOI: 10.1093/ckj/sfaa274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 11/12/2022] Open
Abstract
Avoiding the use of drugs in patients with a glomerular filtration rate (GFR) <30 mL/min/1.73 m2 is due to the exclusion of this group of patients from many clinical trials. However, in view of the widespread COVID-19 pandemic and the need to treat all patients, including those with renal failure, the World Health Organization points out in the Solidarity trial the need for the inclusion some patients with kidney failure and recognizes the urgent need for trials/studies in patients with coronavirus disease 2019 (COVID-19) with lower GFR. It is well known that the therapeutic goal to treat patients with renal failure, acute kidney injury or on maintenance dialysis is complicated by pharmacokinetics, drug interactions and extracorporeal therapies. In patients with COVID-19 and impaired kidney function, the role of nephrologists is crucial in order to draw a balance between nihilism and benefits or potentially harmful effects of current available treatments. The potential use of European Medicines Agency recommended remdesivir and dexamethasone for COVID-19 among dialysis patients are discussed.
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Affiliation(s)
- Mariusz Kusztal
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Marek Myślak
- Center of Nephrology and Kidney Transplantation, Regional Hospital, Szczecin, Poland
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Co-administration of Favipiravir and the Remdesivir Metabolite GS-441524 Effectively Reduces SARS-CoV-2 Replication in the Lungs of the Syrian Hamster Model. mBio 2021; 13:e0304421. [PMID: 35100870 PMCID: PMC8805032 DOI: 10.1128/mbio.03044-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide since December 2019, causing coronavirus disease 2019 (COVID-19). Although vaccines for this virus have been developed rapidly, repurposing drugs approved to treat other diseases remains an invaluable treatment strategy. Here, we evaluated the inhibitory effects of drugs on SARS-CoV-2 replication in a hamster infection model and in in vitro assays. Favipiravir significantly suppressed virus replication in hamster lungs. Remdesivir inhibited virus replication in vitro, but was not effective in the hamster model. However, GS-441524, a metabolite of remdesivir, effectively suppressed virus replication in hamsters. Co-administration of favipiravir and GS-441524 more efficiently reduced virus load in hamster lungs than did single administration of either drug for both the prophylactic and therapeutic regimens; prophylactic co-administration also efficiently inhibited lung inflammation in the infected animals. Furthermore, pretreatment of hamsters with favipiravir and GS-441524 effectively protected them from virus transmission via respiratory droplets upon exposure to infected hamsters. Repurposing and co-administration of antiviral drugs may help combat COVID-19. IMPORTANCE During a pandemic, repurposing drugs that are approved for other diseases is a quick and realistic treatment option. In this study, we found that co-administration of favipiravir and the remdesivir metabolite GS-441524 more effectively blocked SARS-CoV-2 replication in the lungs of Syrian hamsters than either favipiravir or GS-441524 alone as part of a prophylactic or therapeutic regimen. Prophylactic co-administration also reduced the severity of lung inflammation. Moreover, co-administration of these drugs to naive hamsters efficiently protected them from airborne transmission of the virus from infected animals. Since both drugs are nucleotide analogs that interfere with the RNA-dependent RNA polymerases of many RNA viruses, these findings may also help encourage co-administration of antivirals to combat future pandemics.
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A Valid Warning or Clinical Lore: an Evaluation of Safety Outcomes of Remdesivir in Patients with Impaired Renal Function from a Multicenter Matched Cohort. Antimicrob Agents Chemother 2021; 65:AAC.02290-20. [PMID: 33229428 PMCID: PMC7849020 DOI: 10.1128/aac.02290-20] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/19/2020] [Indexed: 12/24/2022] Open
Abstract
Per prescribing guidance, remdesivir is not recommended for SARS-CoV-2 in patients with renal disease given the absence of safety data in this patient population. This study was a multicenter, retrospective chart review of hospitalized patients with SARS-CoV-2 who received remdesivir. Per prescribing guidance, remdesivir is not recommended for SARS-CoV-2 in patients with renal disease given the absence of safety data in this patient population. This study was a multicenter, retrospective chart review of hospitalized patients with SARS-CoV-2 who received remdesivir. Safety outcomes were compared between patients with an estimated creatinine clearance (eCrCl) of <30 ml/min and an eCrCl of ≥30 ml/min. The primary endpoint was acute kidney injury (AKI) at the end of treatment (EOT). Of 359 patients who received remdesivir, 347 met inclusion criteria. Patients with an eCrCl of <30 ml/min were older {median, 80 years (interquartile range [IQR], 63.8 to 89) versus 62 (IQR, 54 to 74); P < 0.001}, were more likely to be on vasopressors on the day of remdesivir administration (30% versus 12.7%; P = 0.003), and were more likely to be mechanically ventilated during remdesivir therapy (27.5% versus 12.4%; P = 0.01) than those with an eCrCl of ≥30 ml/min. Despite these confounders, there was no significant difference in the frequency of EOT AKI (5% versus 2.3%; P = 0.283) or early discontinuation due to abnormal liver function tests (LFTs) (0% versus 3.9%; P = 0.374). Of the 5% of patients who developed EOT AKI on remdesivir with an eCrCl <30 ml/min, no cases were attributable to remdesivir administration per the treating physician. Comparable safety outcomes were observed when 1:1 nearest neighbor matching was applied to account for baseline confounders. In conclusion, remdesivir administration was not significantly associated with increased EOT AKI in patients with an eCrCl of <30 ml/min compared to patients with an eCrCl of ≥30 ml/min.
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Peyko V, Ladd H, Cutrona A. The Safe Administration of Remdesivir in a Patient with Acute Kidney Injury Requiring Hemodialysis. Case Rep Infect Dis 2020; 2020:8811798. [PMID: 33425407 PMCID: PMC7771254 DOI: 10.1155/2020/8811798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 11/21/2022] Open
Abstract
Remdesivir is a nucleoside analog prodrug with broad-spectrum antiviral activity, including against coronaviruses. This has prioritized the inclusion of remdesivir in coronavirus disease 2019 (COVID-19) clinical trials. The United States Food and Drug Administration has granted emergency use authorization for remdesivir. This emergency use authorization does not recommend the use of remdesivir in patients with estimated glomerular filtration rate (eGFR) less than 30 mL/min unless the benefits outweigh the risks. To date, there are no studies and scant information in the literature evaluating remdesivir utilization in patients with eGFR less than 30 mL/min or receiving hemodialysis. With little utilization data for patients with acute or chronic kidney injury, remdesivir may not be considered, leaving this patient population without the opportunity of a potentially beneficial treatment option. We present a case of one patient with eGFR less than 30 mL/min that required hemodialysis in which remdesivir was safely initiated, with therapy completed without any serious adverse events.
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Affiliation(s)
- Vincent Peyko
- Mercy Health–St Elizabeth Boardman Hospital, Department of Pharmacy, 8401 Market St., Boardman, Youngstown, OH 44512, USA
| | - Helena Ladd
- Mercy Health–St Elizabeth Boardman Hospital, Department of Pharmacy, 8401 Market St., Boardman, Youngstown, OH 44512, USA
| | - Anthony Cutrona
- NEO Infectious Diseases Associates, 540 Parmalee Ave., Ste. 610, Youngstown, OH 44510, USA
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