Delayed Initiation of Remdesivir in a COVID‐19‐Positive Patient

Abstract

We present a case of late initiation of remdesivir antiviral therapy in the successful treatment of a patient with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in a mixed medical intensive care unit of a community teaching hospital. A previously healthy 40‐year‐old man was admitted to the hospital 3 days after the onset of coronavirus disease 2019 (COVID‐19) symptoms including dry cough, fever, and shortness of breath progressing to intubation and increased mechanical ventilator support. A request for compassionate use remdesivir was submitted on the same hospital day as the positive COVID‐19 polymerase chain reaction result. Supportive measures, in addition to a 5‐day course of hydroxychloroquine, were maintained until remdesivir could be supplied on day 9 of hospitalization, 13 days after symptom onset. Sixty hours after initiating remdesivir, the patient was successfully extubated and able to transition to room air within 24 hours of extubation. Late initiation of remdesivir may be effective in treating SARS‐CoV‐2, unlike antivirals utilized for different disease states, such as oseltamivir, that are most effective when started as soon as possible following symptom onset. Urgent action is needed by regulatory agencies to work with drug manufacturers to expedite the study and approval of investigational agents targeting SARS‐CoV‐2 as well as to meet manufacturing demands.

COVID-19: Immunology and treatment options

“…This is in keeping with aforementioned phases of the disease with highest virus replication rates early in disease, and host-mediated damage through immune responses at later stages. A recent case report, however, highlights persisting benefits also if late administration [151].…”

COVID-19 Pandemic: an Overview of epidemiology, pathogenesis, Diagnostics and Potential Vaccines and Therapeutics

“…A very recent case study was published showing the advantage of delayed administration of RDV to patients with severe SAR-COV-2-associated pneumonia. The patient received RDV on day 13 of symptoms and showed significant improvement in respiratory symptoms (extubation) after 6 h of RDV first dose [87]. An NIH-supported clinical trial is being conducted in the USA.…”

Current approaches for target-specific drug discovery using natural compounds against SARS-CoV-2 infection

“…The nucleoside inhibitor (Gilead‘s Nuc inhibitor) which has shown disappointment in the treatment of Ebola is effective in the treatment of a 2019-CoV patient in the USA, but the higher rate of mutation in this virus have restricted the use of this drug for treating the n-Cov patients ( Nguyen et al, 2020 ). Moreover, remdesivir another drug recommended for the treatment of Ebola and other RNA viruses have also been found useful in some of the patients ( Gordon et al, 2020 ; Hillaker et al, 2020 ; Shannon et al, 2020 ). Recently anti-influenza drug favipiravir or avigan was considered as an efficient treatment regimen for COVID-19 patients as compared to other antiviral agents ( Chibber et al, 2020 ; Rosa and Santos, 2020 ; Zhu et al, 2020 ).…”