Short-term use of remdesivir in patients with moderate to severe COVID-19 who are on hemodialysis may prevent progression to critical illness, investigator suggest.
Among 118 patients on hemodialysis who contracted COVID-19 during the Omicron surge in South Korea in early 2022, 44 patients (37.3%) consented to receive remdesivir during hospitalization. Remdesivir was administered to patients with moderate COVID-19 within 7 days of symptom onset or severe COVID-19. They received half the standard dose via injection after hemodialysis.
The composite outcome of mortality, use of a high-flow nasal cannula, and transfer to the intensive care unit occurred in a significantly lower proportion of the remdesivir vs no remdesivir group: 2.3% vs 13.5%. In multivariate logistic regression analyses, remdesivir use was significantly associated with 99% decreased odds of the composite outcome, Jang-Hee Cho, MD, PhD, of Kyungpook National University School of Medicine, in Daegu, South Korea and colleagues reported in Kidney International Reports. Remdesivir was also significantly associated with 92% decreased odds of disease severity aggravation, which occurred in 6.8% vs 20.3% of the groups, respectively.
Most patients received remdesivir within 48 hours of hospitalization. Dr Cho’s team pointed out that “early initiation of remdesivir therapy may be necessary to improve outcomes in patients with COVID-19 who are on hemodialysis, and severity of infection has to be considered before use.”
No patients experienced anaphylaxis or hypersensitivity reaction after remdesivir. The investigators noted that sulfobutylether-β-cyclodextrin, a vehicle for remdesivir, is a safety concern but it is eliminated by dialysis possibly reducing risks. Elevation of liver enzymes during hospitalization did not differ between groups.
“The findings of the present study may provide evidence of safety and efficacy of remdesivir in the treatment of patients with COVID-19 who are on hemodialysis,” Dr Cho’s team concluded.
Lim JH, Park SD, Jeon Y, et al. Clinical effectiveness and safety of remdesivir in hemodialysis patients with COVID-19. Kidney Int Rep. Published online September 10, 2022. doi:10.1016/j.ekir.2022.08.031