Early initiation of remdesivir and its effect on oxygen desaturation: A clinical review study among high-risk COVID-19 patients in Myanmar

Aye, Than-Than; Myat, Kaung; Tun, HponePyae; Thiha, Phyo; Han, TinMyo; Win, YinYin; Han, AyeMoh Moh

doi:10.4103/jfmpc.jfmpc_2350_21

Cited by 3 publications

(3 citation statements)

References 17 publications

(27 reference statements)

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“…Randomized controlled trials (RCT) have confirmed this null effect that recruited similar cohorts conducted in high and upper-middle-income countries [ 9 ]. A shorter SORT interval of fewer than three days did not confer a mortality benefit, contradicting previous studies [ 10 , 11 ]. However, our study design limits the validity of these interpretations.…”

Section: Discussioncontrasting

confidence: 89%

COVID-19 Mortality and Remdesivir – A Retrospective Cohort in Intensive Care Setting

Xavier,

Nair,

Shajahan

et al. 2023

Cureus

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Background: Remdesivir is a broad-spectrum antiviral drug that received emergency use authorization in the first wave of the COVID-19 pandemic. However, its effectiveness in preventing mortality in COVID-19 patients who required intensive care was unclear. Patients and methods: We retrospectively analyzed clinical data of 302 patients from intensive care units of a quaternary care center with moderate to severe COVID-19 illness and followed them until discharge between March 2020 and February 2021. Participants who received at least five doses of Remdesivir were compared against participants who received standard care. The primary outcome was all-cause mortality. Secondary outcomes included invasive mechanical ventilation, clinical worsening, and intensive care stay. Results: Remdesivir use was not associated with all-cause mortality in this cohort (age and sex-adjusted OR = 0.76, 95% CI 0.4 -1.5, p = 0.409). However, when stratified for clinical severity and steroid use, Remdesivir demonstrated a strong negative association with all-cause mortality in severely ill patients (OR 0.3, 95% CI 0.1 - 0.6, p = 0.003) or when used along with intravenous Methylprednisolone (Infusion/Bolus, OR 0.2/0.3, 95% CI 0.1 - 0.9 p = 0.06). Remdesivir use was not significantly associated with invasive mechanical ventilation or clinical worsening but with prolonged ICU stay. Conclusion: While Remdesivir use may not affect all-cause mortality in moderate to severely ill COVID-19 ICU patients, it may still benefit severely ill patients or when used with intravenous steroids. However, the limitations of the present study necessitate a randomized controlled trial to test this combined intervention strategy.

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Section: Discussioncontrasting

confidence: 89%

COVID-19 Mortality and Remdesivir – A Retrospective Cohort in Intensive Care Setting

Xavier,

Nair,

Shajahan

et al. 2023

Cureus

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“…Apart from pivotal studies, limited real-world data supporting the effectiveness of early remdesivir therapy in decreasing the overall risk of hospitalization and disease progression in SARS-CoV-2 high-risk outpatients are currently available ( 14 , 15 ). In addition, real-life data focusing on the safety and effectiveness of early remdesivir among the elderly are limited.…”

Section: Introductionmentioning

confidence: 99%

Early 3‑day course of remdesivir for the prevention of the progression to severe COVID‑19 in the elderly: A single‑centre, real‑life cohort study

et al. 2023

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Remdesivir, a viral RNA polymerase inhibitor, has constituted a key component of therapeutic regimens against the pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Originally approved for administration in hospitalized patients, remdesivir leads to improved outcomes in patients with moderate to severe coronavirus disease 2019 (COVID-19). After proving to be effective in hospitalized patients, its use gained approval in early-stage disease for symptomatic outpatients who are at a high risk of progression to severe disease. The present study is a real-life prospective cohort study involving 143 elderly non-hospitalized patients with SARS-CoV-2 (≥65 years of age) who attended the emergency department of the authors' hospital seeking care for COVID-19 symptoms appearing within the prior 7 days. Eligible patients received intravenous remdesivir at a dose of 200 mg on the first day and 100 mg on days 2 and 3. The efficacy endpoints were set as the need for COVID-19-related hospitalization and all-cause mortality in the following 28 days. A total of 143 patients participated in the study. Of these patients, 118 (82.5%) patients were vaccinated with at least two doses. All patients enrolled completed the 3-day course, with a total of 6 out of 143 patients (4.2%) having a COVID-19-related hospitalization by day 28, and 5 patients (3.5%) succumbing to the disease within the study period. In the univariate Cox regression analysis, the neutrophil-to-lymphocyte ratio and haematological malignancy were identified as predictors of progression to severe disease, and albumin levels, the C-reactive protein-to-albumin ratio (CAR) and haematological malignancy were identified as predictors of 28-day mortality. On the whole, the findings of the present study demonstrated that among the elderly outpatients, a 3-day course of intravenous remdesivir was associated with favourable outcomes.

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“…Early administration of a 5-day course of remdesivir (within two days of admission) was associated with a significantly shorter time to clinical improvement, lower viral load [ 26 ] and positive IgG antibodies, reduced length of hospital stay, and lower risk of in-hospital death [ 27 ]. In another retrospective single-center study, the threshold of clinical benefit was set to 9 days from symptom onset for the initiation of RDV when significantly lower all-cause mortality was documented ( p = 0.004) [ 28 ]. Keeping in mind that testing is delayed for several days following manifestations, other authors showed that if RDV was initiated within three days of a positive test result, the length of stay was shorter ( p = 0.03), in addition to the mortality rate and the need for MV [ 29 ].…”

Section: Remdesivir Outcomesmentioning

confidence: 99%

Remdesivir Use in the Real-World Setting: An Overview of Available Evidence

Akinosoglou,

Rigopoulos,

Schinas

et al. 2023

Viruses

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In the years of Coronavirus Disease 2019 (COVID-19), various treatment options have been utilized. COVID-19 continues to circulate in the global population, and the evolution of the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has posed significant challenges to the treatment and prevention of infection. Remdesivir (RDV), an anti-viral agent with in vitro efficacy against coronaviruses, is a potent and safe treatment as suggested by a plethora of in vitro and in vivo studies and clinical trials. Emerging real-world data have confirmed its effectiveness, and there are currently datasets evaluating its efficacy and safety against SARS-CoV-2 infections in various clinical scenarios, including some that are not in the SmPC recommendations according for COVID-19 pharmacotherapy. Remdesivir increases the chance of recovery, reduces progression to severe disease, lowers mortality rates, and exhibits beneficial post-hospitalization outcomes, especially when used early in the course of the disease. Strong evidence suggests the expansion of remdesivir use in special populations (e.g., pregnancy, immunosuppression, renal impairment, transplantation, elderly and co-medicated patients) where the benefits of treatment outweigh the risk of adverse effects. In this article, we attempt to overview the available real-world data of remdesivir pharmacotherapy. With the unpredictable course of COVID-19, we need to utilize all available knowledge to bridge the gap between clinical research and clinical practice and be sufficiently prepared for the future.

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Early initiation of remdesivir and its effect on oxygen desaturation: A clinical review study among high-risk COVID-19 patients in Myanmar

Cited by 3 publications

References 17 publications

COVID-19 Mortality and Remdesivir – A Retrospective Cohort in Intensive Care Setting

COVID-19 Mortality and Remdesivir – A Retrospective Cohort in Intensive Care Setting

Early 3‑day course of remdesivir for the prevention of the progression to severe COVID‑19 in the elderly: A single‑centre, real‑life cohort study

Remdesivir Use in the Real-World Setting: An Overview of Available Evidence

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