Clinical and Virologic Effectiveness of Remdesivir Treatment for Severe Coronavirus Disease 2019 (COVID-19) in Korea: a Nationwide Multicenter Retrospective Cohort Study

Abstract

Background Remdesivir is widely used for the treatment of coronavirus disease 2019 (COVID-19), but controversies regarding its efficacy still remain. Methods A retrospective cohort study was conducted to evaluate the effect of remdesivir on clinical and virologic outcomes of severe COVID-19 patients from June to July 2020. Primary clinical endpoints included clinical recovery, additional mechanical ventilator (MV) support, and duration of oxygen or MV support. Viral load reduction by hospital day (HD) 15 was evaluated by calculating changes in cycle threshold (Ct) values. Results A total of 86 severe COVID-19 patients were evaluated including 48 remdesivir-treated patients. Baseline characteristics were not significantly different between the two groups. Remdesivir was administered an average of 7.42 days from symptom onset. The proportions of clinical recovery of the remdesivir and supportive care group at HD 14 (56.3% and 39.5%) and HD 28 (87.5% and 78.9%) were not statistically different. The proportion of patients requiring MV support by HD 28 was significantly lower in the remdesivir group than in the supportive care group (22.9% vs. 44.7%, P = 0.032), and MV duration was significantly shorter in the remdesivir group (average, 1.97 vs. 5.37 days; P = 0.017). Analysis of upper respiratory tract specimens demonstrated that increases of Ct value from HD 1–5 to 11–15 were significantly greater in the remdesivir group than the supportive care group (average, 10.19 vs. 5.36; P = 0.007), and the slope of the Ct value increase was also significantly steeper in the remdesivir group (average, 5.10 vs. 2.68; P = 0.007). Conclusion The remdesivir group showed clinical and virologic benefit in terms of MV requirement and viral load reduction, supporting remdesivir treatment for severe COVID-19.

The Efficacy of Remdesivir in Reducing SARS-CoV-2 Viral Load and Its Safety on COVID-19 Patients: A Systematic Review

“…12 Patients requiring mechanical ventilation prior to day 28 of hospitalization were less and the duration of mechanical ventilation was shorter in patients using RDV. 11 These findings supported the clinical efficacy of RDV treatment for COVID-19 patients.…”

“…From On the lower respiratory tract analysis, the RDV group also showed a higher increase in CT values (n = 33; median, 0.99; IQR, 0.26, 1.15) compared to the SoC group (n = 28; median, 0.75; IQR, -0.05, 0.99) but the difference was not significant (P = 0.291). 11 were no significant safety concerns with drug administration. 17 The study included 48 subjects taking RDV known to have comorbid diseases (cardiovascular disease, asthma, pulmonary disease, cancer, liver disease, kidney disease, diabetes and HIV).…”

Lack of correlation between the SARS‐CoV‐2 cycle threshold (Ct) value and clinical outcomes in patients with COVID‐19

“… 7 , 8 C t value has been also used to assess response to antiviral therapy. 9 However, several studies have shown that nasopharyngeal SARS‐CoV‐2 C t values are not associated with COVID‐19 severity and do not support a predictive role for the C t value in the clinical setting. 10 , 11 , 12 , 13 , 14 For example, in a report that included a total of 414 throat swabs collected from 94 patients, there was no obvious difference in viral loads across disease severity.…”

Uso do Remdesivir no tratamento da Covid-19: uma revisão integrativa

“…Entre os estudos de coorte encontrados, sete autores (Grein et al, 2020;Pasquini et al, 2020;Mendez-Echevaría et al, 2021;Flisiak et al, 2021;Ackley et al, 2021;Joo et al, 2021;Aiswarya et al, 2021) Como podemos observar, a maioria dos estudos encontrados relatou uma melhora no quadro dos pacientes tratados com Remdesivir, porém é importante ressaltar que a terapia com o medicamento também apresentou diversos efeitos colaterais, os quais podemos citar:…”