The antiviral drug remdesivir is not currently recommended for use in patients with an estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m2 due to concerns of excipient accumulation. Preliminary study findings indicate, however, that remdesivir can be safely administered to patients with advanced chronic kidney disease (CKD) who contract COVID-19.
In the Canadian Treatments for COVID-19 (CATCO) trial, investigators randomly assigned patients to remdesivir or standard care, regardless of kidney function. Among 1281 patients (median age 74 years), 34 patients receiving remdesivir and 25 patients receiving standard care had a baseline eGFR less than 30 mL/min/1.73 m2. Approximately a quarter of each group were on hemodialysis.
No dose adjustments were made for CKD or dialysis. Clinicians administered intravenous remdesivir at a loading dose of 200 mg on day 1, followed by daily 100-mg doses for 9 days or until discharge.
According to a post hoc analysis, patients receiving remdesivir had nonsignificant 26% decreased odds of all-cause mortality, regardless of sex and baseline eGFR, Srinivas Murthy, MD, CM, MHSc, of the University of British Columbia in Vancouver, Canada, and colleagues reported in JAMA Network Open.
Among patients with an eGFR less than 30 mL/min/1.73 m2, the investigators observed no increased risks for transaminitis or toxic kidney effects at day 5 among those who received remdesivir.
Rates of hospital mortality (40.6% vs 52.0%), new mechanical ventilation (14.8% vs 26.1%), and new dialysis (20.0% vs 21.1%) did not differ significantly between the remdesivir and standard care groups with an eGFR less than 30 mL/min/1.73 m2, respectively.
In analyses of 248 patients with an eGFR less than 60 mL/min/1.73 m2, rates of hospital mortality (35.2% vs 42.1%), new mechanical ventilation (10.6% vs 15.7%), and new dialysis (6.2% vs 5.0%) also did not differ significantly between the remdesivir and standard care groups, respectively.
“These findings suggest that remdesivir can be safely administered in patients with kidney dysfunction, balancing possible risks and benefits,” according to Dr Murthy’s team. “The need for assessing kidney function in the absence of clinical suspicion before and during outpatient administration of remdesivir can be questioned.”
This study is limited by the small number of patients with advanced CKD treated with remdesivir and baseline differences between groups.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Cheng M, Fowler R, Murthy S, Pinto R, Sheehan NL, Tseng A. Remdesivir in patients with severe kidney dysfunction: A secondary analysis of the CATCO randomized trial. JAMA Netw Open. Published August 1, 2022. doi:10.1001/jamanetworkopen.2022.29236