Efficacy and Safety of Remdesivir in COVID-19 Positive Dialysis Patients

Abstract

(1) Background: Immune compromised hemodialysis patients are more likely to develop COVID-19 infections, which increase the risk of mortality. The benefits of Remdesivir, despite less literature support on its effectiveness in dialysis patients due to renal toxicity, can outweigh the risks if prescribed early. The aim of this study was to evaluate the efficacy of Remdesivir on the 30-day in-hospital clinical outcome of hemodialysis population with COVID-19 infection and safety endpoints of adverse events. (2) Study design: A prospective quasi-experimental study design was used in the study. (3) Methods: The sample population consisted of 83 dialysis patients with COVID-19 who were administered Remdesivir at a dose of 100 mg before hemodialysis, as per hospital protocol. After the treatment with Remdesivir, we assessed the outcomes across two endpoints, namely primary (surviving vs. dying) as well as clinical and biochemical changes (ferritin, liver function test, C-reactive protein, oxygen requirements, and lactate dehydrogenase levels) and secondary (adverse effects, such as diarrhea, rise in ALT). In Kaplan–Meier analysis, the survival probabilities were compared between patients who received Remdesivir within 48 h of diagnosis and those who received it after 48 h. Cox regression analysis was employed to determine the predictors of outcome. (4) Results: Of the 83 patients, 91.5% survived and 8.4% died. Remdesivir administration did not reduce the death rate overall. Hospital stays were shorter (p = 0.03) and a nasopharyngeal swab for COVID-19 was negative earlier (p = 0.001) in survivors who had received Remdesivir within 48 h of diagnosis compared to those who had received Remdesivir after 48 h. The only variables linked to the 30-day mortality were serum CRP (p = 0.028) and TLC (p = 0.013). No major adverse consequences were observed with Remdesivir. (5) Conclusions: Remdesivir has the potential to shorten the recovery time for dialysis patients if taken within 48 h of onset of symptoms, without any adverse effects.

Safety profile and clinical results of Remdesivir in Hemodialysis patients infected with SARS-CoV-2. A single-center Spanish cohort study

“…Unlike other published studies in which remdesivir correlated with a decrease in hospital stay and shortened recovery time [ 2 – 5 ], its use, despite being well-tolerated and not having shown any adverse effects, did not seem beneficial in our population. Our main limitation is the small sample size that may have caused a Type II error (false-negative results) to surface; however, our study differs from the previously published ones in other relevant aspects.…”

“…In May 2020, remdesivir was the first antiviral drug to be approved by the US Food and Drug Administration (FDA) for emergency use in moderate-to-severe COVID-19. Its mechanism of action consists in inhibiting the viral RNA-dependent RNA polymerase (RdRp) [ 2 ]. Remdesivir is not recommended in patients with an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m 2 due to the presumed toxicity of the drug itself and the accumulation of its solubilizing excipient sulfobutyl ether β -cyclodextrin (SBECD) [ 2 ].…”

“…Its mechanism of action consists in inhibiting the viral RNA-dependent RNA polymerase (RdRp) [ 2 ]. Remdesivir is not recommended in patients with an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m 2 due to the presumed toxicity of the drug itself and the accumulation of its solubilizing excipient sulfobutyl ether β -cyclodextrin (SBECD) [ 2 ]. Initially, this drug was associated with a reduction in morbidity and mortality.…”

“…Later, through two larger clinical trials (Solidarity and ACTT-1), it was found only to improve recovery times and shorten hospital stays [ 3 ]. Moreover, a prospective, double-blind trial conducted in China found no difference between remdesivir and placebo in early recovery [ 2 ]. More data regarding the safety profile and use of remdesivir in end-stage kidney disease (ESKD) have emerged [ 3 , 4 ].…”

Safety of Remdesivir in Covid Patients with Acute or Chronic Kidney Disease

“…8 However, it was also seen that if administered within 48 hours after the onset of symptoms, this drug, Remdesivir, has the potential to help dialysis patients recover more quickly with no adverse effects. 9 Other antiviral drugs such as molnupiravir which doesn't have these side effects are currently unavailable in Pakistan. 9 Keeping in light the effect of this antiviral regimen on kidney functions, our study aimed to evaluate the safety of antiviral drug Remdesivir in patients with acute and chronic kidney and renal disease.…”