Effects of remdesivir on SARS-CoV-2 viral dynamics and mortality in viraemic patients hospitalized for COVID-19
Background: Studies on the antiviral effects of remdesivir have shown conflicting results. SARS-CoV-2 viraemia could identify patients in whom antiviral treatment may be particularly beneficial.
Objectives: To investigate antiviral effects and clinical outcomes of remdesivir treatment in viraemic patients. Methods: Viraemic patients hospitalized for COVID-19 with ratio of arterial oxygen partial pressure to fractional inspired oxygen of ≤300, symptom duration ≤10 days, and estimated glomerular filtration rate ≥30 mL/min were included in a cohort. The rate of serum viral clearance and serum viral load decline, 60 day mortality and in-hospital outcomes were estimated. A subgroup analysis including patients with symptom duration ≤7 days was performed. Results: A total of 318 viraemic patients were included. Thirty-three percent (105/318) received remdesivir. The rate of serum viral clearance [subhazard risk ratio (SHR) 1.4 (95% CI 0.9-2.0), P = 0.11] and serum viral load decline (P = 0.11) were not significantly different between remdesivir-treated patients and controls. However, the rate of serum viral clearance was non-significantly higher [SHR 1.6 (95% CI 1.0-2.7), P = 0.051] and the viral load decline was faster (P = 0.03) in remdesivir-treated patients with symptom duration ≤7 days at admission. The 60 day mortality [HR 1.0 (95% CI 0.6-1.8), P = 0.97] and adverse in-hospital outcomes [OR 1.4 (95% CI 0.8-2.4), P = 0.31] were not significantly different between remdesivir-treated patients and controls. Conclusions: Remdesivir treatment did not significantly change the duration of SARS-CoV-2 viraemia, decline of serum viral load, 60 day mortality or in-hospital adverse outcomes in patients with ≤10 days of symptoms at admission. Remdesivir appeared to reduce the duration of viraemia in a subgroup of patients with ≤7 days of symptoms at admission.
Ethics The Swedish Ethical Review Authority approved of the study (registration numbers 2020-01770 and 2020-06337). Informed consent was waived.
Author contributions Conceptualization: K.H., M.H., P.G.-J., J.U. Methodology: K.H., M.H., J.J., J.U. Investigation: K.H., J.W., M.H., E.A., B.H., L.G., J.U. Data curation: K.H., B.H., L.G., J.U. Formal analysis: K.H., J.U. Writing-original draft: K.H., J.U. Writing-review and editing: K.H., J.W., M.H., E.A., B.H., L.G., J.J., P.G.-J., J.U. Visualization: K.H., J.U.
Supplementary data Figure S1 and Tables S1 to S8 are available as Supplementary data at JAC Online.
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