Remdesivir and Human Milk: A Case Study

Abstract

Introduction: Remdesivir was originally developed to treat Ebola hemorrhagic fever, and its efficacy in treating coronavirus disease 2019 was detected during a preliminary analysis of a randomized controlled trial. It is known that Severe Acute Respiratory Syndrome Coronavirus 2 is not transmitted through human milk, but data about the presence of remdesivir in human milk have been lacking. Main issue: In this case study, we determined the human milk-to-serum drug concentration ratio and the relative dose of Remdesivir in one participant. Management: The participant, a 28-year-old primipara, was found to have Coronavirus 2 infection in 2019, 2 days after delivery. She was given Remdesivir. The Remdesivir concentration in maternal serum and human milk was measured, and the milk-to-serum drug concentration ratio was found to be low (0.089), as was the relative infant dose (0.0070). The participant could not breastfeed her infant during her Coronavirus 2 infection treatment because in Japan anyone with COVID-19 was completely quarantined. However, she was able to resume breastfeeding after discharge and breastfed her infant for 6 months with supplements. Conclusion: Given the low amount of Remdesivir in the participant’s milk, the inclusion of antibodies to Severe Acute Respiratory Syndrome Coronavirus 2, which can be expected to protect the infant from infection, and various other benefits of human milk, suggests that breastfeeding is safe during treatment with Remdesivir.

Remdesivir in treating hospitalized patients with COVID-19: A renewed review of clinical trials

“…A study reported the concentration of remdesivir metabolite GS-441524 in maternal serum was 33.1–389.9 ng/ml and in human milk was 13.50–284.9 ng/ml. The half-lives of GS-441524 in maternal serum and milk were 25.1 and 9.3 h respectively ( Wada et al, 2022 ). Therefore, it is urgent to evaluate the efficacy of remdesivir in pregnant patients, which requires more clinical trials.…”

“…A 28-year-old primipara after delivery 2 days who was diagnosed with COVID-19, and then she was given remdesivir. The remdesivir concentration in maternal serum and breast milk was measured, and the ratio of drug concentration in milk to serum was low (0.089), as was the relative infant dose (0.0070%), which suggested that breastfeeding was safe during treatment with remdesivir and can be expected to protect the infant from infection ( Wada et al, 2022 ).…”

Update on Remdesivir in the Treatment of Novel Coronavirus Pneumonia

“…Figure 3 illustrates the mechanism action of in vivo SARS-CoV-2 inhibition of Remdesivir. It has been suggested that GS-441524, a precursor compound phosphorylated to GS-443902, inhibits SARS-COV-2 both in vitro and in vivo and is a superior compound for treating COVID-19 [53,54] . Brunotte and Schloer et al [55] found that GS-441524 and fluoxetine displayed good tolerance and antiviral effects against SARS-CoV-2 variants.…”

H‐Bonded Supramolecular Crystals‐Coated Solid‐Phase Microextraction enables the Matrix Interference‐Free Detection of the COVID‐19 Antiviral Drugs

“…[14] It is particularly important to track and adjust the dosage of drugs used by patients after infection with COVID-19, as blindly conforming to the previous dosage may lead to subtherapeutic or toxic effects. [15,16] Meanwhile, since DDI may exist between different drugs, leading to unpredictable drug levels in the body, dose adjustments should be made according to individuals. [17] Therapeutic drug monitoring (TDM) is crucial for the effectiveness and safety of treatment.…”