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COVID-19 and Kidney Transplantation: The impact of remdesivir on renal function and outcome - a retrospective cohort study

Elec et al., International Journal of Infectious Diseases, doi:10.1016/j.ijid.2022.03.015
Mar 2022  
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Mortality 19% Improvement Relative Risk Ventilation 11% ICU admission -72% Remdesivir for COVID-19  Elec et al.  LATE TREATMENT Is late treatment with remdesivir beneficial for COVID-19? Retrospective 165 patients in Romania (March 2020 - May 2021) Higher ICU admission with remdesivir (p=0.01) c19early.org Elec et al., Int. J. Infectious Diseases, Mar 2022 Favorsremdesivir Favorscontrol 0 0.5 1 1.5 2+
Retrospective 165 hospitalized COVID-19+ kidney transplant patients, 38 treated with remdesivir, showing no significant difference in mortality, higher ICU admission, and lower ICU mortality. Subject to confounding by time with significant changes to SOC and treatment propensity during the study period.
Gérard, Zhou, Wu, Kamo, Choi show significantly increased risk of acute kidney injury with remdesivir.
Remdesivir efficacy disappears with longer followup. Mixed-effects meta-regression of efficacy as a function of followup duration across all remdesivir studies shows decreasing efficacy with longer followup6. This may reflect antiviral efficacy being offset by serious adverse effects of treatment.
Followup duration (days) Efficacy Remdesivir mortality efficacy decreases with longer followup 0 15 30 45 60 75 90 105 -25% 0% 25% 50% c19early.org October 2024 mixed-effects meta-regression slope -0.58 [95% CI -0.92 to -0.24] p=0.00089
This study is excluded in the after exclusion results of meta analysis: substantial confounding by time possible due to significant changes in SOC and treatment propensity during the study period.
risk of death, 19.3% lower, RR 0.81, p = 0.66, treatment 7 of 38 (18.4%), control 29 of 127 (22.8%), NNT 23.
risk of mechanical ventilation, 10.9% lower, RR 0.89, p = 0.73, treatment 8 of 38 (21.1%), control 30 of 127 (23.6%), NNT 39.
risk of ICU admission, 71.9% higher, RR 1.72, p = 0.01, treatment 18 of 38 (47.4%), control 35 of 127 (27.6%).
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Elec et al., 14 Mar 2022, retrospective, Romania, peer-reviewed, 9 authors, study period 1 March, 2020 - 31 May, 2021.
This PaperRemdesivirAll
COVID-19 and kidney transplantation: the impact of remdesivir on renal function and outcome - a retrospective cohort study
MD Florin Elec, Jesper Magnusson, Alina Elec, Adriana Muntean, Oana Antal, Tudor Moisoiu, Cristina Cismaru, Mihaela Lupse, Mihai Oltean
International Journal of Infectious Diseases, doi:10.1016/j.ijid.2022.03.015
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
CONFLICT OF INTEREST There are no conflicts of interests to be reported
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Late treatment
is less effective
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