Clinical outcomes and considerations in outpatient with COVID‐19 receiving remdesivir therapy
Zeinab Siami, Aziz Rasooli, Jayran Zebardast, Illahay Jalali, Saeidreza Jamalimoghadamsiahkali
Health Science Reports, doi:10.1002/hsr2.2252
Introduction: This retrospective cross-sectional study aimed to assess the outcomes of Covid-19 patients who received remdesivir therapy at the outpatient department of Ziaian Hospital. Method: A total of 514 eligible patients were included between May and September 2021. Covid-19 diagnosis was confirmed through positive SARS-COV-2 PCR tests or chest CT scans. Due to limited hospital beds, patients received remdesivir on an outpatient basis. Results: Patients received six daily doses of remdesivir for 5 days. Those referred to a physician within 7 days of symptom onset had similar hospitalization rates compared to later referrals. Lower blood saturation levels were associated with a higher likelihood of hospital admission, indicating that earlier administration of remdesivir may be more effective. Patients with over 50% lung involvement had higher rates of disease progression despite treatment. Corticosteroids did not significantly improve outcomes in patients with saturation above 90%. Discontinuation of remdesivir due to side effects was rare, with only 1% experiencing increased liver enzymes, 1.2% facial redness and tremors, and 1.5% allergies. After 1 week of treatment, patients commonly reported symptoms such as hair loss, fatigue, body pain, lethargy, and anorexia, particularly among hospitalized patients. Discussion: Patients generally preferred outpatient treatment over hospitalization. Body mass index (BMI) did not significantly impact hospitalization rates, although average weight tended to be higher among inpatients. The study confirmed the effectiveness of remdesivir therapy with a low occurrence of side effects.
After adjusting for these variables, the odds ratio for adverse outcomes was 1.58, indicating a slightly increased risk, although this result was not statistically significant (p = 0.2). Similarly, after adjustment, the odds ratio for was 1.7, suggesting a higher likelihood of hospitalization, but this result did not reach statistical significance (p = 0.2). While we did not achieve statistical significance after adjusting for age and sex, it is important to note that the study sample size was relatively small, which may have limited the statistical power to detect significant effects. Future studies with larger sample sizes are warranted to further investigate the relationship between remdesivir and adverse outcomes or hospitalization. The safety profile of remdesivir was also evaluated in our study, and overall, the drug was well-tolerated, with no major adverse events reported during the study period. This finding aligns with previous evidence indicating the favorable safety profile of remdesivir. However, it is important to continue monitoring the safety of remdesivir as more data becomes available from larger clinical trials and real-world use. While our study provides valuable insights into the effectiveness and safety of remdesivir, there are several limitations to consider. Firstly, the study had a retrospective design, which may introduce selection bias and limit causal inference. Additionally, the sample size was relatively small, which may have affected the ability..
References
Ansems, Grundeis, Dahms, Remdesivir for the treatment of COVID-19, Cochrane Database Syst Rev
Beigel, Tomashek, Dodd, Remdesivir for the treatment of Covid-19, N Engl J Med
Burwick, Yawetz, Stephenson, Compassionate use of remdesivir in pregnant women with severe coronavirus disease 2019, Clin Infect Dis
Costanzo, Giglio, Roviello, SARS-CoV-2: Recent reports on antiviral therapies based on lopinavir/ritonavir, darunavir/umifenovir, hydroxychloroquine, remdesivir, favipiravir and other drugs for the treatment of the new coronavirus, Curr Med Chem
Fraser, Brierley, Dey, Preprinting the COVID-19 pandemic, bioRxiv
Gianola, Jesus, Bargeri, Castellini, Characteristics of academic publications, preprints, and registered clinical trials on the COVID-19 pandemic, PLoS One
Guo, Cao, Hong, The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreakan update on the, Mil Med Res
Guterman, Braunstein, Preprints during the COVID-19 pandemic: Public health emergencies and medical literature, Journal of Hospital Medicine
Hafeez, Ahmad, Siddqui, A review of COVID-19 (Coronavirus Disease-2019) diagnosis, treatments and prevention, EJMO
Hanson, Caliendo, Arias, Infectious diseases society of America guidelines on the diagnosis of coronavirus disease 2019, Clin Infect Dis
Li, Cao, Li, Remdesivir metabolite GS-441524 effectively inhibits SARS-CoV-2 infection in mouse models, J Med Chem
Li, Wang, Cao, Sun, Li et al., Rapid review for the anticoronavirus effect of remdesivir, Drug Discoveries & Therapeutics
Lin, Cho, Aravamudan, Remdesivir in coronavirus disease 2019 (COVID-19) treatment: a review of evidence, Infection
Liu, Zheng, Liu, Serum IgM against SARS-CoV-2 correlates with in-hospital mortality in severe/critical patients with COVID-19 in wuhan, China, Aging
Mulangu, Dodd, Rt, A randomized, controlled trial of Ebola virus disease therapeutics, N Engl J Med
Pasupuleti, Tsai, Ponnusamy, Pugazhendhi, Rapid determination of remdesivir (SARS-CoV-2 drug) in human plasma for therapeutic drug monitoring in COVID-19-patients, Process Biochem
Roshanshad, Kamalipour, Ashraf, The efficacy of remdesivir in coronavirus disease 2019 (COVID-19): a systematic review, Iran J Microbiol
Rostad, Chahroudi, Mantus, Quantitative SARS-CoV-2 serology in children with multisystem inflammatory syndrome (MIS-C), Pediatrics
Siami, Rasooli, Zebardast, Jalali, Jamalimoghadamsiahkali, Clinical outcomes and considerations in outpatient with COVID-19 receiving remdesivir therapy, Health Sci Rep
Singh, Khera, Chugh, Khera, Chugh, Efficacy and safety of remdesivir in COVID-19 caused by SARS-CoV-2: a systematic review and meta-analysis, BMJ Open
Wang, Cao, Zhang, Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro, Cell Res
Wang, Zhou, Zhang, Evaluation of the efficacy and safety of intravenous remdesivir in adult patients with severe COVID-19: Study protocol for a phase 3 randomized, double-blind, placebocontrolled, multicentre trial, Trials
Wong, Lau, Au, Xiong, Lau et al., Clinical improvement, outcomes, antiviral activity, and costs associated with early treatment with remdesivir for patients with coronavirus disease 2019 (COVID-19), Clin Infect Dis
Wu, Wang, Kuo, An update on current therapeutic drugs treating COVID-19, Current Pharmacology Reports
Yang, Wei, Chang, Remdesivir use in the coronavirus disease 2019 pandemic: a mini-review, J Microbiol Immunol Infect
Älgå, Eriksson, Nordberg, The development of preprints during the COVID-19 pandemic, J Intern Med
{ 'indexed': {'date-parts': [[2024, 7, 28]], 'date-time': '2024-07-28T00:16:46Z', 'timestamp': 1722125806195},
'reference-count': 25,
'publisher': 'Wiley',
'issue': '7',
'license': [ { 'start': { 'date-parts': [[2024, 7, 22]],
'date-time': '2024-07-22T00:00:00Z',
'timestamp': 1721606400000},
'content-version': 'vor',
'delay-in-days': 21,
'URL': 'http://creativecommons.org/licenses/by/4.0/'}],
'content-domain': {'domain': ['onlinelibrary.wiley.com'], 'crossmark-restriction': True},
'published-print': {'date-parts': [[2024, 7]]},
'abstract': '<jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>This '
'retrospective cross‐sectional study aimed to assess the outcomes of Covid‐19 patients who '
'received remdesivir therapy at the outpatient department of Ziaian '
'Hospital.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>A total of 514 '
'eligible patients were included between May and September 2021. Covid‐19 diagnosis was '
'confirmed through positive SARS‐COV‐2 PCR tests or chest CT scans. Due to limited hospital '
'beds, patients received remdesivir on an outpatient '
'basis.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Patients received '
'six daily doses of remdesivir for 5 days. Those referred to a physician within 7 days of '
'symptom onset had similar hospitalization rates compared to later referrals. Lower blood '
'saturation levels were associated with a higher likelihood of hospital admission, indicating '
'that earlier administration of remdesivir may be more effective. Patients with over 50% lung '
'involvement had higher rates of disease progression despite treatment. Corticosteroids did '
'not significantly improve outcomes in patients with saturation above 90%. Discontinuation of '
'remdesivir due to side effects was rare, with only 1% experiencing increased liver enzymes, '
'1.2% facial redness and tremors, and 1.5% allergies. After 1 week of treatment, patients '
'commonly reported symptoms such as hair loss, fatigue, body pain, lethargy, and anorexia, '
'particularly among hospitalized '
'patients.</jats:p></jats:sec><jats:sec><jats:title>Discussion</jats:title><jats:p>Patients '
'generally preferred outpatient treatment over hospitalization. Body mass index (BMI) did not '
'significantly impact hospitalization rates, although average weight tended to be higher among '
'inpatients. The study confirmed the effectiveness of remdesivir therapy with a low occurrence '
'of side effects.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>This '
'retrospective study evaluated the outcomes of Covid‐19 patients receiving remdesivir at an '
'outpatient department. Early administration of remdesivir showed better outcomes, while '
'corticosteroids had limited benefits. Outpatient treatment was favored, and BMI did not '
'significantly influence hospitalization rates. Remdesivir demonstrated efficacy with a low '
'incidence of side effects.</jats:p></jats:sec>',
'DOI': '10.1002/hsr2.2252',
'type': 'journal-article',
'created': {'date-parts': [[2024, 7, 23]], 'date-time': '2024-07-23T03:44:42Z', 'timestamp': 1721706282000},
'update-policy': 'http://dx.doi.org/10.1002/crossmark_policy',
'source': 'Crossref',
'is-referenced-by-count': 0,
'title': 'Clinical outcomes and considerations in outpatient with COVID‐19 receiving remdesivir therapy',
'prefix': '10.1002',
'volume': '7',
'author': [ { 'ORCID': 'http://orcid.org/0000-0002-0587-0705',
'authenticated-orcid': False,
'given': 'Zeinab',
'family': 'Siami',
'sequence': 'first',
'affiliation': [ { 'name': 'Department of Infectious Disease, School of Medicine, Ziaeian '
'Hospital Tehran University of Medical Sciences Tehran Iran'}]},
{ 'ORCID': 'http://orcid.org/0000-0002-6573-2742',
'authenticated-orcid': False,
'given': 'Aziz',
'family': 'Rasooli',
'sequence': 'additional',
'affiliation': [ { 'name': 'Department of Emergency Medicine Tehran University of Medical, '
'Sciences Tehran Iran'}]},
{ 'ORCID': 'http://orcid.org/0000-0002-0551-0988',
'authenticated-orcid': False,
'given': 'Jayran',
'family': 'Zebardast',
'sequence': 'additional',
'affiliation': [ { 'name': 'Department of Cognitive Linguistics Institute for Cognitive '
'Science Studies (ICSS) Tehran Iran'}]},
{ 'given': 'Illahay',
'family': 'Jalali',
'sequence': 'additional',
'affiliation': [ { 'name': 'Department of Infectious Disease, School of Medicine Tehran '
'University of Medical, Sciences Tehran Iran'}]},
{ 'ORCID': 'http://orcid.org/0000-0002-4171-6676',
'authenticated-orcid': False,
'given': 'Saeidreza',
'family': 'Jamalimoghadamsiahkali',
'sequence': 'additional',
'affiliation': [ { 'name': 'Department of Infectious Disease, School of Medicine, Ziaeian '
'Hospital Tehran University of Medical Sciences Tehran Iran'}]}],
'member': '311',
'published-online': {'date-parts': [[2024, 7, 22]]},
'reference': [ { 'key': 'e_1_2_9_2_1',
'doi-asserted-by': 'publisher',
'DOI': '10.1371/journal.pone.0240123'},
{ 'key': 'e_1_2_9_3_1',
'article-title': 'Preprinting the COVID‐19 pandemic',
'volume': '2',
'author': 'Fraser N',
'year': '2021',
'journal-title': 'bioRxiv'},
{'key': 'e_1_2_9_4_1', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/joim.13240'},
{'key': 'e_1_2_9_5_1', 'doi-asserted-by': 'publisher', 'DOI': '10.12788/jhm.3491'},
{'key': 'e_1_2_9_6_1', 'doi-asserted-by': 'publisher', 'DOI': '10.1007/s40495-020-00216-7'},
{ 'issue': '2',
'key': 'e_1_2_9_7_1',
'first-page': '116',
'article-title': 'A review of COVID‐19 (Coronavirus Disease‐2019) diagnosis, treatments '
'and prevention',
'volume': '4',
'author': 'Hafeez A',
'year': '2020',
'journal-title': 'EJMO'},
{'key': 'e_1_2_9_8_1', 'doi-asserted-by': 'publisher', 'DOI': '10.1186/s40779-020-00240-0'},
{'key': 'e_1_2_9_9_1', 'doi-asserted-by': 'publisher', 'DOI': '10.1007/s15010-020-01557-7'},
{ 'issue': '8',
'key': 'e_1_2_9_10_1',
'article-title': 'Remdesivir for the treatment of COVID‐19',
'volume': '8',
'author': 'Ansems K',
'year': '2021',
'journal-title': 'Cochrane Database Syst Rev'},
{ 'issue': '5',
'key': 'e_1_2_9_11_1',
'first-page': '376',
'article-title': 'The efficacy of remdesivir in coronavirus disease 2019 (COVID‐19): a '
'systematic review',
'volume': '12',
'author': 'Roshanshad A',
'year': '2020',
'journal-title': 'Iran J Microbiol'},
{'key': 'e_1_2_9_12_1', 'doi-asserted-by': 'publisher', 'DOI': '10.1056/NEJMoa2007764'},
{'key': 'e_1_2_9_13_1', 'doi-asserted-by': 'publisher', 'DOI': '10.1093/cid/ciab631'},
{'key': 'e_1_2_9_14_1', 'doi-asserted-by': 'publisher', 'DOI': '10.1093/cid/ciaa1466'},
{ 'key': 'e_1_2_9_15_1',
'first-page': 'e385',
'article-title': 'Infectious diseases society of America guidelines on the diagnosis of '
'coronavirus disease 2019',
'volume': '78',
'author': 'Hanson KE',
'year': '2020',
'journal-title': 'Clin Infect Dis'},
{'key': 'e_1_2_9_16_1', 'doi-asserted-by': 'publisher', 'DOI': '10.18632/aging.103417'},
{ 'key': 'e_1_2_9_17_1',
'doi-asserted-by': 'publisher',
'DOI': '10.1136/bmjopen-2020-048416'},
{'key': 'e_1_2_9_18_1', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.jmii.2020.09.002'},
{ 'key': 'e_1_2_9_19_1',
'doi-asserted-by': 'publisher',
'DOI': '10.1016/j.procbio.2020.12.014'},
{ 'key': 'e_1_2_9_20_1',
'doi-asserted-by': 'publisher',
'DOI': '10.2174/0929867327666200416131117'},
{'key': 'e_1_2_9_21_1', 'doi-asserted-by': 'publisher', 'DOI': '10.5582/ddt.2020.01015'},
{ 'key': 'e_1_2_9_22_1',
'doi-asserted-by': 'publisher',
'DOI': '10.1021/acs.jmedchem.0c01929'},
{'key': 'e_1_2_9_23_1', 'doi-asserted-by': 'publisher', 'DOI': '10.1542/peds.2020-018242'},
{'key': 'e_1_2_9_24_1', 'doi-asserted-by': 'publisher', 'DOI': '10.1186/s13063-020-04352-9'},
{'key': 'e_1_2_9_25_1', 'doi-asserted-by': 'publisher', 'DOI': '10.1056/NEJMoa1910993'},
{'key': 'e_1_2_9_26_1', 'doi-asserted-by': 'publisher', 'DOI': '10.1038/s41422-020-0282-0'}],
'container-title': 'Health Science Reports',
'original-title': [],
'language': 'en',
'link': [ { 'URL': 'https://onlinelibrary.wiley.com/doi/pdf/10.1002/hsr2.2252',
'content-type': 'unspecified',
'content-version': 'vor',
'intended-application': 'similarity-checking'}],
'deposited': { 'date-parts': [[2024, 7, 27]],
'date-time': '2024-07-27T04:00:39Z',
'timestamp': 1722052839000},
'score': 1,
'resource': {'primary': {'URL': 'https://onlinelibrary.wiley.com/doi/10.1002/hsr2.2252'}},
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2024, 7]]},
'references-count': 25,
'journal-issue': {'issue': '7', 'published-print': {'date-parts': [[2024, 7]]}},
'alternative-id': ['10.1002/hsr2.2252'],
'URL': 'http://dx.doi.org/10.1002/hsr2.2252',
'relation': {},
'ISSN': ['2398-8835', '2398-8835'],
'subject': [],
'container-title-short': 'Health Science Reports',
'published': {'date-parts': [[2024, 7]]},
'assertion': [ { 'value': '2023-07-01',
'order': 0,
'name': 'received',
'label': 'Received',
'group': {'name': 'publication_history', 'label': 'Publication History'}},
{ 'value': '2024-05-27',
'order': 2,
'name': 'accepted',
'label': 'Accepted',
'group': {'name': 'publication_history', 'label': 'Publication History'}},
{ 'value': '2024-07-22',
'order': 3,
'name': 'published',
'label': 'Published',
'group': {'name': 'publication_history', 'label': 'Publication History'}}]}
