1
|
Molaei E, Molaei A, Hayes AW, Karimi G. Remdesivir: treatment of COVID-19 in special populations. Naunyn Schmiedebergs Arch Pharmacol 2024:10.1007/s00210-023-02927-2. [PMID: 38180557 DOI: 10.1007/s00210-023-02927-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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.
Collapse
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.
| |
Collapse
|
2
|
Pantazis N, Pechlivanidou E, Antoniadou A, Akinosoglou K, Kalomenidis I, Poulakou G, Milionis H, Panagopoulos P, Marangos M, Katsarolis I, Kazakou P, Dimakopoulou V, Chaliasou AL, Rapti V, Christaki E, Liontos A, Petrakis V, Schinas G, Biros D, Rimpa MC, Touloumi G. Remdesivir: Effectiveness and Safety in Hospitalized Patients with COVID-19 (ReEs-COVID-19)-Analysis of Data from Daily Practice. Microorganisms 2023; 11:1998. [PMID: 37630558 PMCID: PMC10459397 DOI: 10.3390/microorganisms11081998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Remdesivir was the first antiviral approved for treating COVID-19. We investigated its patterns of use, effectiveness and safety in clinical practice in Greece. This is a retrospective observational study of hospitalized adults who received remdesivir for COVID-19 in September 2020-February 2021. The main endpoints were the time to recovery (hospital discharge within 30 days from admission) and safety. The "early" (remdesivir initiation within 24 h since hospitalization) and "deferred" (remdesivir initiation later on) groups were compared. One thousand and four patients (60.6% male, mean age 61 years, 74.3% with severe disease, 70.9% with ≥1 comorbidities) were included, and 75.9% of them were on a 5-day regimen, and 86.8% were in the early group. Among those with a baseline mild/moderate disease, the median (95% CI) time to recovery was 8 (7-9) and 12 (11-14) days for the early and deferred groups, respectively (p < 0.001). The corresponding estimates for those with a severe disease were 10 (9-10) and 13 (11-15) days, respectively (p = 0.028). After remdesivir initiation, increased serum transaminases and an acute kidney injury were observed in 6.9% and 2.1%, respectively. Nine (0.9%) patients discontinued the treatment due to adverse events. The effectiveness of remdesivir was increased when it was taken within 24 h since admission regardless of the disease severity. Remdesivir's safety profile is similar to that described in clinical trials and other real-world cohorts.
Collapse
Affiliation(s)
- Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National & Kapodistrian University of Athens, 11527 Athens, Greece
| | - Evmorfia Pechlivanidou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National & Kapodistrian University of Athens, 11527 Athens, Greece
| | - Anastasia Antoniadou
- 4th Department of Internal Medicine, Attikon University General Hospital, Medical School, National & Kapodistrian University of Athens, 12461 Athens, Greece
| | - Karolina Akinosoglou
- Department of Internal Medicine, University General Hospital of Patras, Department of Medicine, University of Patras, 26504 Rio, Greece
| | - Ioannis Kalomenidis
- 1st Department of Critical Care & Pulmonary Service, Evangelismos General Hospital, Medical School, National & Kapodistrian University of Athens, 10676 Athens, Greece
- COVID-19 Unit, Evangelismos General Hospital, 10676 Athens, Greece
| | - Garyfallia Poulakou
- 3rd Department of Internal Medicine, Athens Hospital for Diseases of the Chest “Sotiria”, Medical School, National & Kapodistrian University of Athens, 11527 Athens, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, University General Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece (D.B.)
| | - Periklis Panagopoulos
- Department of Internal Medicine, University General Hospital of Alexandroupolis, Department of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Markos Marangos
- Department of Internal Medicine, University General Hospital of Patras, Department of Medicine, University of Patras, 26504 Rio, Greece
| | - Ioannis Katsarolis
- Medical Affairs, Gilead Sciences Hellas and Cyprus, 17564 Paleo Faliro, Greece
| | - Pinelopi Kazakou
- 4th Department of Internal Medicine, Attikon University General Hospital, Medical School, National & Kapodistrian University of Athens, 12461 Athens, Greece
| | - Vasiliki Dimakopoulou
- Department of Internal Medicine, University General Hospital of Patras, Department of Medicine, University of Patras, 26504 Rio, Greece
| | | | - Vasiliki Rapti
- 3rd Department of Internal Medicine, Athens Hospital for Diseases of the Chest “Sotiria”, Medical School, National & Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eirini Christaki
- Department of Internal Medicine, University General Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece (D.B.)
| | - Angelos Liontos
- Department of Internal Medicine, University General Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece (D.B.)
| | - Vasileios Petrakis
- Department of Internal Medicine, University General Hospital of Alexandroupolis, Department of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Georgios Schinas
- Department of Internal Medicine, University General Hospital of Patras, Department of Medicine, University of Patras, 26504 Rio, Greece
| | - Dimitrios Biros
- Department of Internal Medicine, University General Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece (D.B.)
| | - Maria-Christina Rimpa
- Department of Internal Medicine, University General Hospital of Alexandroupolis, Department of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National & Kapodistrian University of Athens, 11527 Athens, Greece
| |
Collapse
|
3
|
Quesada Muñoz L, Fernández-Fradejas J, Martinez-Barros H, Sánchez Cuervo M, Martín Rufo M, Pintor Recuenco MDR, Quereda Rodríguez-Navarro C, Álvarez-Díaz AM, Saez de la Fuente J. Real-world effectiveness and factors associated with increased mortality in non-critically ill patients with COVID-19 pneumonia receiving remdesivir. Eur J Hosp Pharm 2023:ejhpharm-2023-003729. [PMID: 37339865 DOI: 10.1136/ejhpharm-2023-003729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/06/2023] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVES Evidence on the effectiveness of remdesivir when used in real-life clinical practice is controversial. This study aims to analyse its effectiveness and the factors associated with increased mortality in non-critically ill patients with COVID-19 pneumonia who require supplemental low-flow oxygen and received remdesivir. METHODS A retrospective cohort study was conducted at Ramón y Cajal University Hospital (Madrid, Spain) which included all patients treated with remdesivir in our institution during the second pandemic breakout in Spain, from August to November 2020. Treatment with remdesivir was limited to non-critically ill patients with COVID-19 pneumonia requiring low-flow supplemental oxygen, with a treatment duration of 5 days. RESULTS A total of 1757 patients were admitted with COVID-19 pneumonia during the study period, of which 281 non-critically ill patients were treated with remdesivir and included in the analysis. Mortality at 28 days after initiation of treatment was 17.1%. The median (IQR) time to recovery was 9 days (6-15). 104 (37.0%) patients had complications during hospitalisation, with renal failure being the most frequent (31 patients; 36.5%). After adjustment for confounding factors, high-flow oxygen therapy was associated with increased 28-day mortality (HR 2.77; 95% CI 1.39 to 5.53; p=0.004) and decreased 28-day clinical improvement (HR 0.54; 95% CI 0.35 to 0.85; p=0.008). A significant difference in survival and clinical improvement was identified between patients treated with high and low-flow oxygen. CONCLUSION The 28-day mortality rate in patients treated with remdesivir needing low-flow oxygen therapy was higher than that published in clinical trials. Age and increased oxygen therapy needed after the beginning of treatment were the main risk factors associated with mortality.
Collapse
|
4
|
Pham HT, Mai-Phan TA, Vu AK, Truong TH, Tran MH. Clinical use of remdesivir in COVID-19 treatment: a retrospective cohort study. BMJ Open 2023; 13:e070489. [PMID: 37295834 PMCID: PMC10276957 DOI: 10.1136/bmjopen-2022-070489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVES This study investigated remdesivir's clinical use to provide direct evidence of effectiveness for a low-middle income Asian setting. DESIGN A one-to-one propensity score matching retrospective cohort study. SETTING A tertiary hospital with COVID-19 treatment facilities in Vietnam. PARTICIPANTS A total of 310 patients in standard of care (SoC) group were matched with 310 patients in SoC+remdesivir (SoC+R) group. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was time to critical progression, defined as all-cause mortality or critical illness. The secondary outcomes were length of oxygen therapy/ventilation and need for invasive mechanical ventilation. Outcome reports were presented as HR, OR or effect difference with 95% CI. RESULTS Patients receiving remdesivir had a lower risk for mortality or critical illness (HR=0.68, 95% CI 0.47 to 0.96, p=0.030). Remdesivir was not associated with a shorter length of oxygen therapy/ventilation (effect difference -0.17 days, 95% CI -1.29 to 0.96, p=0.774). The need for invasive mechanical ventilation was lower in SoC+R group (OR=0.57, 95% CI 0.38 to 0.86, p=0.007). CONCLUSIONS This study's results showing remdesivir's benefits in non-critical patients with COVID-19 may be extrapolated to other similar low-middle income countries, allowing more regimens for limited resource areas and reducing poor outcomes and equity gap worldwide.
Collapse
Affiliation(s)
- Hong Tham Pham
- Department of Pharmacy, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Tuong-Anh Mai-Phan
- Department of Surgical Gastroenterology, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam
- Department of General Planning, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Anh Kiet Vu
- Department of General Planning, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Thi Ha Truong
- Department of Pharmacy, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Minh-Hoang Tran
- Department of Pharmacy, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| |
Collapse
|
5
|
Petrakis V, Rapti V, Akinosoglou K, Bonelis C, Athanasiou K, Dimakopoulou V, Syrigos NK, Spernovasilis N, Trypsianis G, Marangos M, Gogos C, Papazoglou D, Panagopoulos P, Poulakou G. Greek Remdesivir Cohort (GREC) Study: Effectiveness of Antiviral Drug Remdesivir in Hospitalized Patients with COVID-19 Pneumonia. Microorganisms 2022; 10:microorganisms10101949. [PMID: 36296225 PMCID: PMC9611983 DOI: 10.3390/microorganisms10101949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 03/03/2023] Open
Abstract
In several randomized studies, remdesivir (RDV) has been reported to shorten the recovery period and improve clinical outcomes in COVID-19 patients, and thus, it is recommended as a standard of care. Nevertheless, controversial reports have been published. The aim of the present study is to evaluate the effectiveness of remdesivir in hospitalized patients with COVID-19 pneumonia at three Greek University Departments of Infectious Diseases with homogenous treatment protocols. From September 2020 to February 2021, we retrospectively analyzed adults hospitalized with confirmed SARS-CoV-2 infection and radiological findings of pneumonia, who received remdesivir once daily for five days. Exploratory end points were duration of hospitalization, time of intubation, and death. Overall, 551 patients were included in the study. The optimal cutoff point for the number of days needed after symptom initiation for drug administration associated with better clinical outcome was 7 days. Higher odds for discharge and lower for intubation were observed in patients with treatment initiation ≤7 days (p = 0.052 and p = 0.019, retrospectively) regardless of gender (p = 0.537), hypertension (p = 0.096), dyslipidemia (p = 0.221), diabetes mellitus (p = 0.306), and usage of immunomodulators (p = 0.408). Our study has demonstrated beneficial effects of early treatment with remdesivir (≤7 days from symptom onset) on rates of intubation and probability of discharge.
Collapse
Affiliation(s)
- Vasilis Petrakis
- 2nd Department of Internal Medicine, Democritus University of Thrace, University General Hospital Alexandroupolis, 68100 Alexadroupolis, Greece
| | - Vasiliki Rapti
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria General Hospital, 11527 Athens, Greece
- Correspondence: (V.R.); (G.P.)
| | - Karolina Akinosoglou
- Department of Internal Medicine and Infectious Diseases, Medical School, University of Patras, 26504 Patras, Greece
| | - Constantinos Bonelis
- 2nd Department of Internal Medicine, Democritus University of Thrace, University General Hospital Alexandroupolis, 68100 Alexadroupolis, Greece
| | - Kalomoira Athanasiou
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria General Hospital, 11527 Athens, Greece
| | - Vasiliki Dimakopoulou
- Department of Internal Medicine, Medical School, University of Patras, 26504 Patras, Greece
| | - Nikolaos K. Syrigos
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria General Hospital, 11527 Athens, Greece
- Harvard School of Public Health, Boston, MA 02115, USA
| | - Nikolaos Spernovasilis
- School of Medicine, University of Crete, 71500 Heraklion, Greece
- Department of Infectious Diseases, German Oncology Center, Limassol 4108, Cyprus
| | - Grigoris Trypsianis
- Department of Medical Statistics, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Markos Marangos
- Department of Internal Medicine and Infectious Diseases, Medical School, University of Patras, 26504 Patras, Greece
| | - Charalambos Gogos
- Department of Internal Medicine, Medical School, University of Patras, 26504 Patras, Greece
| | - Dimitrios Papazoglou
- 2nd Department of Internal Medicine, Democritus University of Thrace, University General Hospital Alexandroupolis, 68100 Alexadroupolis, Greece
| | - Periklis Panagopoulos
- 2nd Department of Internal Medicine, Democritus University of Thrace, University General Hospital Alexandroupolis, 68100 Alexadroupolis, Greece
| | - Garyfallia Poulakou
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria General Hospital, 11527 Athens, Greece
- Correspondence: (V.R.); (G.P.)
| |
Collapse
|
6
|
Ticinesi A, Tuttolomondo D, Nouvenne A, Parise A, Cerundolo N, Prati B, Zanichelli I, Guerra A, Gaibazzi N, Meschi T. Co-Administration of Remdesivir and Azithromycin May Protect against Intensive Care Unit Admission in COVID-19 Pneumonia Requiring Hospitalization: A Real-Life Observational Study. Antibiotics (Basel) 2022; 11:antibiotics11070941. [PMID: 35884195 PMCID: PMC9311950 DOI: 10.3390/antibiotics11070941] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023] Open
Abstract
The benefits of remdesivir treatment, with or without co-administration of antibiotics such as azithromycin, are uncertain in COVID-19 pneumonia. The aim of this retrospective single-center study was to assess the effects of remdesivir, with or without azithromycin, on hospital mortality, intensive care unit (ICU) admission, and need of non-invasive ventilation. The clinical records of the COVID-19 patients hospitalized in an Italian ward in March 2021 were analyzed, and data on comorbidities and clinical, radiological, and laboratory presentation of the disease were collected. Among 394 participants (234 M), 173 received remdesivir (43.9%), including 81 with azithromycin (20.5%). Remdesivir recipients were younger, with less comorbidities, and had better PaO2/FiO2 and clinical outcomes, including reduced mortality, but the differences were not independent of covariates. Rates of ICU transferal were 17%, 9%, and 1% in the no remdesivir, remdesivir without azithromycin, and remdesivir/azithromycin groups, respectively. In a stepwise multivariate logistic regression model, remdesivir/azithromycin co-treatment was independently associated with reduced ICU admission (vs remdesivir alone, OR 0.081, 95% CI 0.008-0.789, p = 0.031; vs no remdesivir, OR 0.060, 95% CI 0.007-0.508, p = 0.010). These data suggest that the therapeutical effect of remdesivir in COVID-19 pneumonia may be potentiated by azithromycin. The association between the two drugs should be further investigated.
Collapse
Affiliation(s)
- Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (D.T.); (I.Z.); (A.G.); (T.M.)
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.N.); (A.P.); (N.C.); (B.P.)
- Correspondence:
| | - Domenico Tuttolomondo
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (D.T.); (I.Z.); (A.G.); (T.M.)
- Department of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy;
| | - Antonio Nouvenne
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.N.); (A.P.); (N.C.); (B.P.)
| | - Alberto Parise
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.N.); (A.P.); (N.C.); (B.P.)
| | - Nicoletta Cerundolo
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.N.); (A.P.); (N.C.); (B.P.)
| | - Beatrice Prati
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.N.); (A.P.); (N.C.); (B.P.)
| | - Ilaria Zanichelli
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (D.T.); (I.Z.); (A.G.); (T.M.)
| | - Angela Guerra
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (D.T.); (I.Z.); (A.G.); (T.M.)
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.N.); (A.P.); (N.C.); (B.P.)
| | - Nicola Gaibazzi
- Department of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy;
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (D.T.); (I.Z.); (A.G.); (T.M.)
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.N.); (A.P.); (N.C.); (B.P.)
| |
Collapse
|
7
|
Ramos-Rincon JM, López-Carmona MD, Cobos-Palacios L, López-Sampalo A, Rubio-Rivas M, Martín-Escalante MD, de-Cossio-Tejido S, Taboada-Martínez ML, Muiño-Miguez A, Areses-Manrique M, Martinez-Cilleros C, Tuñón-de-Almeida C, Abella-Vázquez L, Martínez-Gonzalez AL, Díez-García LF, Ripper CJ, Asensi V, Martinez-Pascual A, Guisado-Vasco P, Lumbreras-Bermejo C, Gómez-Huelgas R, On Behalf Of The Semi-Covid-Network. Remdesivir in Very Old Patients (≥80 Years) Hospitalized with COVID-19: Real World Data from the SEMI-COVID-19 Registry. J Clin Med 2022; 11. [PMID: 35807058 DOI: 10.3390/jcm11133769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 12/15/2022] Open
Abstract
(1) Background: Large cohort studies of patients with COVID-19 treated with remdesivir have reported improved clinical outcomes, but data on older patients are scarce. Objective: This work aims to assess the potential benefit of remdesivir in unvaccinated very old patients hospitalized with COVID-19; (2) Methods: This is a retrospective analysis of patients ≥ 80 years hospitalized in Spain between 15 July and 31 December 2020 (SEMI-COVID-19 Registry). Differences in 30-day all-cause mortality were adjusted using a multivariable regression analysis. (3) Results: Of the 4331 patients admitted, 1312 (30.3%) were ≥80 years. Very old patients treated with remdesivir (n: 140, 10.7%) had a lower mortality rate than those not treated with remdesivir (OR (95% CI): 0.45 (0.29−0.69)). After multivariable adjustment by age, sex, and variables associated with lower mortality (place of COVID-19 acquisition; degree of dependence; comorbidities; dementia; duration of symptoms; admission qSOFA; chest X-ray; D-dimer; and treatment with corticosteroids, tocilizumab, beta-lactams, macrolides, and high-flow nasal canula oxygen), the use of remdesivir remained associated with a lower 30-day all-cause mortality rate (adjusted OR (95% CI): 0.40 (0.22−0.61) (p < 0.001)). (4) Conclusions: Remdesivir may reduce mortality in very old patients hospitalized with COVID-19.
Collapse
|
8
|
Cogliati Dezza F, Oliva A, Mauro V, Romani FE, Aronica R, Savelloni G, Casali E, Valeri S, Cancelli F, Mastroianni CM. Real-life use of remdesivir-containing regimens in COVID-19: a retrospective case-control study. Infez Med 2022; 30:211-222. [PMID: 35693052 PMCID: PMC9177180 DOI: 10.53854/liim-3002-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Remdesivir (REM) has shown potent antiviral activity in vitro and efficacy in animal models of COVID-19; nevertheless, clinical trials and real-life reports have shown conflicting data on its effectiveness. Aims of the study were to evaluate the impact of remdesivir on I) Intensive Care Unit (ICU) admission, II) need for orotracheal intubation (OTI) and III) in-hospital mortality. Furthermore, we estimated the kinetics of laboratory parameters and assessed the risk factors for in-hospital mortality in the remdesivir population. METHODS We conducted a retrospective, single-center, case-control (1:1) study including hospitalized patients with confirmed SARS-CoV-2 infection. Cases were patients treated with remdesivir for 5 days, controls were patients not receiving remdesivir. RESULTS A total of 192 patients (96 cases and 96 controls) were included in the study. Patients receiving remdesivir had a lower rate of ICU admission and need for OTI than controls, whereas no difference between cases and controls were observed as for mortality rate. However, at multivariable analysis remdesivir was not associated with ICU admission neither with OTI. Instead, presence of haematological malignancies, lower duration of symptoms, higher severity of infection and low lymphocytes count at admission were independently associated with in-hospital mortality. In patients treated with remdesivir a low albumin value and duration of lymphopenia were significantly associated with mortality. CONCLUSIONS Our real-life study showed that therapy with remdesivir did not have impact on either ICU admission, need for OTI or in-hospital mortality.
Collapse
Affiliation(s)
- Francesco Cogliati Dezza
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
| | - Vera Mauro
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
| | - Francesco Eugenio Romani
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
| | - Raissa Aronica
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
| | - Giulia Savelloni
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
| | - Elena Casali
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
| | - Serena Valeri
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
| | - Francesca Cancelli
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University, AOU Policlinico Umberto I, Rome, Italy
| |
Collapse
|
9
|
Moreno S, Alcázar B, Dueñas C, González del Castillo J, Olalla J, Antela A. Use of Antivirals in SARS-CoV-2 Infection. Critical Review of the Role of Remdesivir. Drug Des Devel Ther 2022; 16:827-841. [PMID: 35370401 PMCID: PMC8965332 DOI: 10.2147/dddt.s356951] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/04/2022] [Indexed: 12/15/2022] Open
Abstract
The aim of this report is to review the literature and shed light on the uncertainties surrounding the use of antiviral agents in general and remdesivir in COVID-19 patients. This review evaluated a battery of antiviral compounds and their effectiveness in the treatment of COVID-19 since the beginning of the pandemic. Remdesivir is the only antiviral approved by the EMA and FDA for the treatment of SARS-CoV-2 infection. This work extensively reviews remdesivir data generated from clinical trials and observational studies, paying attention to the most recent data, and focusing on outcomes to give readers a more comprehensive understanding of the results. This review also discusses the recommendations issued by official bodies during the pandemic in the light of the current knowledge. The use of remdesivir in the treatment of SARS-CoV-2 infection is justified because a virus is the causative agent that triggers the inflammatory responses and its consequences. More trials are needed to improve the management of this disease.
Collapse
Affiliation(s)
- Santiago Moreno
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Bernardino Alcázar
- Respiratory Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Carlos Dueñas
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Julián Olalla
- Internal Medicine Service, Hospital Costa del Sol, Marbella, Spain
| | - Antonio Antela
- Infectious Diseases Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| |
Collapse
|
10
|
Poliseno M, Gallo C, Cibelli DC, Minafra GA, Bottalico IF, Bruno SR, D’Errico ML, Montemurro L, Rizzo M, Barbera L, Custodero GE, La Marca A, Lo Muzio D, Miucci A, Santantonio TA, Lo Caputo S. Efficacy and Safety of Remdesivir over Two Waves of the SARS-CoV-2 Pandemic. Antibiotics (Basel) 2021; 10:antibiotics10121477. [PMID: 34943688 PMCID: PMC8698274 DOI: 10.3390/antibiotics10121477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/23/2021] [Accepted: 11/29/2021] [Indexed: 02/05/2023] Open
Abstract
The aim of this study is to describe the features, the outcomes, and the clinical issues related to Remdesivir administration of a cohort of 220 patients (pts) with COVID-19 hospitalized throughout the last two pandemic waves in Italy. One hundred and nine pts were enrolled from 1 September 2020, to 28 February 2021 (Group A) and 111 from 1 March to 30 September 2021 (Group B). Notably, no differences were reported between the two groups neither in the timing of hospitalization. nor in the timing of Remdesivir administration from symptoms onset. Remarkably, a higher proportion of pts with severe COVID-19 was observed in Group B (25% vs. 10%, p < 0.001). At univariate and multivariate analysis, rather than the timing of Remdesivir administration, age, presence of coexisting conditions, D-dimers, and O2 flow at admission correlated positively to progression to non-invasive ventilation, especially for patients in Group B. However, the rate of admission in the Intensive Care Unit and/or death was comparable in the two groups (7% vs. 4%). Negligible variations in serum GOT, GPT, GGT, and eGFR levels were detected. A mean reduction in heart rate was noticed within the first three days of antiviral treatment (p < 0.001). Low rate of ICU admission, high rate of clinical recovery, and good drug safety were observed in COVID-19 patients treated with Remdesivir during two diverse pandemic waves.
Collapse
Affiliation(s)
- Mariacristina Poliseno
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (D.C.C.); (G.A.M.); (I.F.B.); (S.R.B.); (M.L.D.); (L.M.); (M.R.); (L.B.); (G.E.C.); (A.L.M.); (D.L.M.); (A.M.); (T.A.S.); (S.L.C.)
- Correspondence: ; Tel.: +39-3471032012
| | - Crescenzio Gallo
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Donatella Concetta Cibelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (D.C.C.); (G.A.M.); (I.F.B.); (S.R.B.); (M.L.D.); (L.M.); (M.R.); (L.B.); (G.E.C.); (A.L.M.); (D.L.M.); (A.M.); (T.A.S.); (S.L.C.)
| | - Graziano Antonio Minafra
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (D.C.C.); (G.A.M.); (I.F.B.); (S.R.B.); (M.L.D.); (L.M.); (M.R.); (L.B.); (G.E.C.); (A.L.M.); (D.L.M.); (A.M.); (T.A.S.); (S.L.C.)
| | - Irene Francesca Bottalico
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (D.C.C.); (G.A.M.); (I.F.B.); (S.R.B.); (M.L.D.); (L.M.); (M.R.); (L.B.); (G.E.C.); (A.L.M.); (D.L.M.); (A.M.); (T.A.S.); (S.L.C.)
| | - Serena Rita Bruno
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (D.C.C.); (G.A.M.); (I.F.B.); (S.R.B.); (M.L.D.); (L.M.); (M.R.); (L.B.); (G.E.C.); (A.L.M.); (D.L.M.); (A.M.); (T.A.S.); (S.L.C.)
| | - Maria Luca D’Errico
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (D.C.C.); (G.A.M.); (I.F.B.); (S.R.B.); (M.L.D.); (L.M.); (M.R.); (L.B.); (G.E.C.); (A.L.M.); (D.L.M.); (A.M.); (T.A.S.); (S.L.C.)
| | - Laura Montemurro
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (D.C.C.); (G.A.M.); (I.F.B.); (S.R.B.); (M.L.D.); (L.M.); (M.R.); (L.B.); (G.E.C.); (A.L.M.); (D.L.M.); (A.M.); (T.A.S.); (S.L.C.)
| | - Marianna Rizzo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (D.C.C.); (G.A.M.); (I.F.B.); (S.R.B.); (M.L.D.); (L.M.); (M.R.); (L.B.); (G.E.C.); (A.L.M.); (D.L.M.); (A.M.); (T.A.S.); (S.L.C.)
| | - Lucia Barbera
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (D.C.C.); (G.A.M.); (I.F.B.); (S.R.B.); (M.L.D.); (L.M.); (M.R.); (L.B.); (G.E.C.); (A.L.M.); (D.L.M.); (A.M.); (T.A.S.); (S.L.C.)
| | - Giacomo Emanuele Custodero
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (D.C.C.); (G.A.M.); (I.F.B.); (S.R.B.); (M.L.D.); (L.M.); (M.R.); (L.B.); (G.E.C.); (A.L.M.); (D.L.M.); (A.M.); (T.A.S.); (S.L.C.)
| | - Antonella La Marca
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (D.C.C.); (G.A.M.); (I.F.B.); (S.R.B.); (M.L.D.); (L.M.); (M.R.); (L.B.); (G.E.C.); (A.L.M.); (D.L.M.); (A.M.); (T.A.S.); (S.L.C.)
| | - Donatella Lo Muzio
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (D.C.C.); (G.A.M.); (I.F.B.); (S.R.B.); (M.L.D.); (L.M.); (M.R.); (L.B.); (G.E.C.); (A.L.M.); (D.L.M.); (A.M.); (T.A.S.); (S.L.C.)
| | - Anna Miucci
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (D.C.C.); (G.A.M.); (I.F.B.); (S.R.B.); (M.L.D.); (L.M.); (M.R.); (L.B.); (G.E.C.); (A.L.M.); (D.L.M.); (A.M.); (T.A.S.); (S.L.C.)
| | - Teresa Antonia Santantonio
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (D.C.C.); (G.A.M.); (I.F.B.); (S.R.B.); (M.L.D.); (L.M.); (M.R.); (L.B.); (G.E.C.); (A.L.M.); (D.L.M.); (A.M.); (T.A.S.); (S.L.C.)
| | - Sergio Lo Caputo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (D.C.C.); (G.A.M.); (I.F.B.); (S.R.B.); (M.L.D.); (L.M.); (M.R.); (L.B.); (G.E.C.); (A.L.M.); (D.L.M.); (A.M.); (T.A.S.); (S.L.C.)
| |
Collapse
|
11
|
Milushewa PK. Results from Observational Studies in Real Therapeutic Practice in Patients with Covid-19. Acta Medica Bulgarica 2021; 48:56-67. [DOI: 10.2478/amb-2021-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The aim of the present work is to summarize the available data from observational studies performed in a real clinical setting of patients with active COVID-19 infection.A systematic review of publications in the scientific medical literature was conducted during the period from the beginning of the infection to the end of June, 2021. All of the 28 publications included in this review are full-text, observational studies published in English, conducted in a real clinical environment and present data on patients, who have been infected with COVID-19. Out of the 28 studies, 4 reviewed the possibility of a mother to infect her newborn during pregnancy or breastfeeding and found no risk to children. One study was related to children and adolescents of all races and included also patients with MIS-C and comorbidities. Non-invasive mechanical ventilation (HFNC) with a nasal cannula in patients with respiratory failure has been also explored and was reported to lead to a positive outcome. Three papers were dedicated to assessment of COVID-19 Standard of Care (SoC), in particular administration of hydroxychloroquine and doxycycline, favipiravir and remdesivir. Another three articles reviewed a large cohort of hospitalized patients with COVID-19. The mortality was higher in patients who were in the ICU. Observational studies of patients with COVID-19 in a real life setting are relatively limited, but provide valuable information on the risks of the disease in adults, children and newborns, as well as the treatment of complications of the infection.
Collapse
|
12
|
Russo A, Binetti E, Borrazzo C, Cacciola EG, Battistini L, Ceccarelli G, Mastroianni CM, d'Ettorre G. Efficacy of Remdesivir-Containing Therapy in Hospitalized COVID-19 Patients: A Prospective Clinical Experience. J Clin Med 2021; 10:3784. [PMID: 34501233 DOI: 10.3390/jcm10173784] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
Objectives: Remdesivir is currently approved for the treatment of COVID-19. The recommendation for using remdesivir in patients with COVID-19 was based on the in vitro and in vivo activity of this drug against SARS-CoV-2. Methods: This was a prospective observational study conducted on a population of patients hospitalized for COVID-19. The primary endpoint of this study was the impact of remdesivir-containing therapy on 30-day mortality; the secondary endpoint was the impact of remdesivir-containing therapy on the need for high-flow oxygen therapy (HFNC), non-invasive ventilation (NIV), or mechanical ventilation. The data were analyzed after propensity score matching. Results: A total of 407 patients with SARS-CoV-2 pneumonia were consecutively enrolled. Out of these, 294 (72.2%) were treated with remdesivir and 113 (27.8%) were not. Overall, 61 patients (14.9%) were treated during hospitalization with HFNC, NIV, or mechanical ventilation, while 30-day mortality was observed in 21 patients (5.2%). Univariate analysis of patients treated with remdesivir or not showed no differences in 30-day mortality (4% vs. 6%, p = 0.411) in the two study groups. Cox regression analysis, after propensity score matching, showed that therapies, including remdesivir-containing therapy, were not statistically associated with 30-day survival or mortality. The Kaplan–Meier curves of 30-day survival in patients treated with remdesivir or not before (p = 0.24) and after (p = 0.88) propensity score matching showed no differences between the two study groups. Finally, patients treated with remdesivir or not showed the same need for HFNC/NIV or mechanical ventilation. Conclusions: This real-life experience of remdesivir use in hospitalized patients with COVID-19 was not associated with significant increases in rates of survival or reduced use of HFNC/NIV or mechanical ventilation compared with patients treated with other therapies not including remdesivir.
Collapse
|
13
|
Soriano A, Montejano R, Sanz-Moreno J, Figueira JC, Grau S, Güerri-Fernández R, Castro-Gómez A, Pérez-Román I, Hidalgo-Vega Á, González-Domínguez A. Impact of Remdesivir on the Treatment of COVID-19 During the First Wave in Spain. Adv Ther 2021; 38:4057-69. [PMID: 34118007 DOI: 10.1007/s12325-021-01804-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/20/2021] [Indexed: 12/19/2022]
Abstract
Introduction Spain was one of the most affected countries during the first wave of COVID-19, having the highest mortality rate in Europe. The aim of this retrospective study is to estimate the impact that remdesivir—the first drug for COVID-19 approved in the EU—would have had in the first wave. Methods This study simulated the impact that remdesivir could have had on the Spanish National Health System (SNHS) capacity (bed occupancy) and the number of deaths that could have been prevented, based on two scenarios: a real-life scenario (without remdesivir) and an alternative scenario (with remdesivir). It considered the clinical results of the ACTT-1 trial in hospitalized patients with COVID-19 and pneumonia who required supplemental oxygen. The occupancy rates in general wards and ICUs were estimated in both scenarios. Results Remdesivir use could have prevented the admission of 2587 patients (43.75%) in the ICUs. It could have also increased the SNHS capacity in 5656 general wards beds and 1700 ICU beds, showing an increase in the number of beds available of 17.53% (95% CI 3.98%–24.42%) and 23.98% (95% CI 21.33%–28.22%), respectively, at the peak of the occupancy rates. Furthermore, remdesivir use could have prevented 7639 deaths due to COVID-19, which implies a 27.51% reduction (95% CI 14.25%–34.07%). Conclusions Remdesivir could have relieved the pressure on the SNHS and could have reduced the death toll, providing a better strategy for the management of COVID-19 during the first wave. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01804-9.
Collapse
|
14
|
Thangaraju P, Velmurugan H. Does Remdesivir maintain the race in the general treatment protocol of COVID-19? J Family Med Prim Care 2021; 10:4621-4622. [PMID: 35280619 PMCID: PMC8884325 DOI: 10.4103/jfmpc.jfmpc_1552_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/02/2021] [Accepted: 09/29/2021] [Indexed: 11/04/2022] Open
|