Effects of remdesivir on SARS-CoV-2 viral dynamics and mortality in viraemic patients hospitalized for COVID-19

DOI record: { "DOI": "10.1093/jac/dkad295", "ISSN": [ "0305-7453", "1460-2091" ], "URL": "http://dx.doi.org/10.1093/jac/dkad295", "abstract": "<jats:title>Abstract</jats:title>\n <jats:sec>\n <jats:title>Background</jats:title>\n <jats:p>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.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Objectives</jats:title>\n <jats:p>To investigate antiviral effects and clinical outcomes of remdesivir treatment in viraemic patients.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Methods</jats:title>\n <jats:p>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.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Results</jats:title>\n <jats:p>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.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Conclusions</jats:title>\n <jats:p>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.</jats:p>\n </jats:sec>", "author": [ { "ORCID": "http://orcid.org/0000-0002-5965-6130", "affiliation": [ { "name": "Department of Infectious Diseases, Sahlgrenska University Hospital , Diagnosvagen 21, 416 50 Gothenburg , Sweden" }, { "name": "Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet , Stockholm , Sweden" } ], "authenticated-orcid": false, "family": "Hagman", "given": "Karl", "sequence": "first" }, { "ORCID": "http://orcid.org/0000-0001-8539-9820", "affiliation": [ { "name": "Department of Infectious Diseases, Danderyd Hospital , Stockholm , Sweden" } ], "authenticated-orcid": false, "family": "Hedenstierna", "given": "Magnus", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Infectious Diseases, Danderyd Hospital , Stockholm , Sweden" } ], "family": "Widaeus", "given": "Jacob", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Infectious Diseases, Danderyd Hospital , Stockholm , Sweden" } ], "family": "Arvidsson", "given": "Emelie", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Clinical Microbiology, Karolinska University Hospital , Stockholm   Sweden" } ], "family": "Hammas", "given": "Berit", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Clinical Microbiology, Karolinska University Hospital , Stockholm   Sweden" } ], "family": "Grillner", "given": "Lena", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-5829-1803", "affiliation": [ { "name": "Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet , Stockholm , Sweden" }, { "name": "Department of Anaesthesia and Intensive Care, Danderyd Hospital , Stockholm , Sweden" } ], "authenticated-orcid": false, "family": "Jakobsson", "given": "Jan", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Infectious Diseases, Danderyd Hospital , Stockholm , Sweden" } ], "family": "Gille-Johnson", "given": "Patrik", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-5508-9327", "affiliation": [ { "name": "Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet , Stockholm , Sweden" }, { "name": "Department of Infectious Diseases, Danderyd Hospital , Stockholm , Sweden" } ], "authenticated-orcid": false, "family": "Ursing", "given": "Johan", "sequence": "additional" } ], "container-title": "Journal of Antimicrobial Chemotherapy", "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2023, 9, 18 ] ], "date-time": "2023-09-18T21:07:12Z", "timestamp": 1695071232000 }, "deposited": { "date-parts": [ [ 2023, 9, 27 ] ], "date-time": "2023-09-27T21:35:05Z", "timestamp": 1695850505000 }, "funder": [ { "DOI": "10.13039/501100004722", "award": [ "FO2017-0482" ], "doi-asserted-by": "publisher", "name": "Lars Hierta Memorial 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