Remdesivir for pregnancy: A systematic review of antiviral therapy for COVID-19

Abstract

The use of remdesivir for pregnant patients with coronavirus disease 2019 (COVID-19) showed conflicting results in prior studies. We aimed to systematically review its efficacy and safety for this population from the existing literature. Methods: On July 26, 2021, registries (ClinicalTrials.gov) and databases (MEDLINE, ScienceDirect, Cochrane Library, JSTOR, DOAJ, and medRxiv) were systematically searched for research articles investigating remdesivir use in pregnant people with COVID-19. Clinical outcome, hospitalization duration, laboratory outcome, mortality, and adverse events were investigated. Results: We obtained 13 observation studies with 113 pregnant people. In these studies, remdesivir improved the clinical condition of pregnant patients with COVID-19, especially those who had a better clinical status at baseline and received earlier remdesivir treatment. Most fetuses were delivered via cesarean section, primarily because of emergency causes. No vertical transmissions were noted. The most reported adverse event was transaminitis, in which 10-day remdesivir treatment yielded more incidence than the 5-day treatment. Conclusions: In pregnancy, the use of Remdesivir in combination with other COVID-19 treatments is inconclusive but its use should be followed with careful monitoring of adverse reactions and transaminase enzyme levels. Further studies are required to confirm its finding.

Coronavirus Disease-2019 in Pregnancy

“…46 Although the efficacy and safety profile of remdesivir among pregnant women remains inconclusive, a recent systematic review reporting nine case reports and case series demonstrated clinical recovery after remdesivir treatments. 47 Remdesivir improved the clinical condition of pregnant patients with COVID-19, especially those with a better clinical status at baseline and who received treatment earlier in the course of the disease. 47 , 48 The current WHO guidelines updates the use of remdesivir for patients with nonsevere COVID-19: its use reduces hospital admission in the highest risk group, although with little or no impact on mortality.…”

“… 47 Remdesivir improved the clinical condition of pregnant patients with COVID-19, especially those with a better clinical status at baseline and who received treatment earlier in the course of the disease. 47 , 48 The current WHO guidelines updates the use of remdesivir for patients with nonsevere COVID-19: its use reduces hospital admission in the highest risk group, although with little or no impact on mortality. 49 Adverse reactions and transaminase enzyme levels should be followed after remdesivir administration; the most common adverse event following remdesivir treatment is transaminitis.…”

European society of clinical microbiology and infectious diseases guidelines for coronavirus disease 2019: an update on treatment of patients with mild/moderate disease

“…In the compassionate use program patients with severe COVID-19 treated with remdesivir showed good outcome but higher rate of preterm birth. It is unclear if this is related to the antiviral use or a complication of COVID-19[ 38 , 39 ]. This doubt was partially clarified in a study comparing pre-delivery and post-delivery treatment with remdesivir in which the rate of pre-term delivery was similar[ 40 ].…”

Penggunaan Antivirus Remdesivir untuk Pasien COVID-19 dengan Kehamilan: Studi Literatur

“…Kehamilan dengan infeksi dapat menyebabkan terjadinya gawat janin dan persalinan prematur. Angka kematian pada wanita hamil akibat COVID-19 mencapai 25% dari populasi (Budi et al, 2022;Favilli et al, 2020;Juanita et al, 2021;Kundarto & Faizah, 2021). Hingga saat ini, pengetahuan tentang COVID-19 yang berhubungan dengan kehamilan dan janin masih terbatas dan belum ada rekomendasi yang dikeluarkan oleh WHO secara spesifik untuk penanganan COVID-19 pada kehamilan.…”