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Incidence of bradycardia with the use of remdesivir for coronavirus disease of 2019 and risk factor analysis

Steele et al., International Journal of Critical Illness and Injury Science, doi:10.4103/ijciis.ijciis_57_24
Oct 2024  
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Retrospective 124 hospitalized COVID-19 patients showing that 49% of patients treated with remdesivir developed bradycardia. Mortality was significantly higher in the bradycardia group (26.2% vs 11.1%).
Gérard, Zhou, Wu, Kamo, Choi, Kim show significantly increased risk of acute kidney injury with remdesivir.
Steele et al., 31 Oct 2024, retrospective, USA, peer-reviewed, 5 authors, study period 1 October, 2020 - 1 October, 2021. Contact: 6@osu.edu.
This PaperRemdesivirAll
Incidence of bradycardia with the use of remdesivir for coronavirus disease of 2019 and risk factor analysis
Samantha M Steele, Dr Anthony Thomas Gerlach, Jessica L Elefritz, Heena H Sadaqat, Megan K Phelps
International Journal of Critical Illness and Injury Science, doi:10.4103/ijciis.ijciis_57_24
Background: Remdesivir is commonly used for inpatient treatment of coronavirus disease of 2019 (COVID-19) and may be associated with bradycardia. The objective is to investigate the incidence of bradycardia in patients with COVID-19 receiving remdesivir and evaluate potential risk factors associated with bradycardia. Methods: This single-center, retrospective, cohort study evaluated the incidence of bradycardia during and up to 48 h after remdesivir administration in adults admitted to the medical center for treatment of COVID-19. Secondary endpoints included time to bradycardia after remdesivir administration, incidence of severe bradycardia, incidence of early remdesivir discontinuation due to bradycardia, interventions to treat bradycardia, and inpatient mortality. Univariate analyses were performed to determine factors associated with remdesivir-related bradycardia. Risk factors significant at the 0.20 level in the univariate analysis were entered into a stepwise backward regression analysis to evaluate potential risk factors. Results: Bradycardia occurred in 61 (49.2%) of patients with a median nadir of 50 bpm. Median baseline heart rate (HR) was lower in patients who developed bradycardia (79 [67-89] vs. 91 [80-100] P < 0.001). Patients who developed bradycardia had a trend for more nonblack race, higher severity of illness, concurrent acute respiratory distress syndrome diagnosis, history of liver disease, and less hypomagnesemia. Only baseline HR as measured before remdesivir initiation was independently associated with bradycardia by multivariate analysis. Patients who developed bradycardia had a higher inpatient mortality (26.2% vs. 11.1%, P = 0.03). Conclusion: Remdesivir-associated bradycardia is common. Baseline HR was identified as an independent risk factor for bradycardia in hospitalized patients being treated with remdesivir for COVID-19.
Conflicts of interest There are no conflicts of interest.
References
Ai, Chang, Yang, Remdesivir-induced bradycardia and mortality in SARS-CoV-2 infection, potential risk factors assessment: A systematic review and meta-analysis, J Clin Med
Ards Definition, Force, Ranieri, Rubenfeld, Thompson et al., Acute respiratory distress syndrome: The Berlin Definition, JAMA
Attena, Albani, Maraolo, Mollica, Rosa et al., Remdesivir-Induced bradycardia in COVID-19: A single center prospective study, Circ Arrhythm Electrophysiol
Bellomo, Ronco, Kellum, Mehta, Palevsky, Acute renal failure -Definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group, Crit Care
Brunetti, Poliseno, Bottalico, Centola, Montemurro et al., Safety and heart rate changes in Covid-19 patients treated with Remdesivir, Int J Infect Dis
Frost, Jimenez-Solem, Ankarfeldt, Nyeland, Andreasen et al., The adaptive COVID-19 treatment trial-1 (ACTT-1) in a real-world population: A comparative observational study, Crit Care
Gordon, Tchesnokov, Woolner, Perry, Feng et al., Remdesivir is a direct-acting antiviral that inhibits RNA-dependent RNA polymerase from severe acute respiratory syndrome coronavirus 2 with high potency, J Biol Chem
Kumar, Arcuri, Chaudhuri, Gupta, Aseri et al., A novel study on SARS-COV-2 virus associated bradycardia as a predictor of mortality-retrospective multicenter analysis, Clin Cardiol
Pallotto, Blanc, Esperti, Suardi, Gabbuti et al., Remdesivir treatment and transient bradycardia in patients with coronavirus diseases 2019 (COVID-19), J Infect
Pallotto, Suardi, Gabbuti, Esperti, Mecocci et al., Potential remdesivir-related transient bradycardia in patients with coronavirus disease 2019 (COVID-19), J Med Virol
Remdesivir, None
Schreiber, Bauzon, Batra, Mohammed, Lee et al., Clinical Characteristics and implications of bradycardia in COVID-19 patients treated with remdesivir: A single-center retrospective cohort study, Clin Drug Investig
Seymour, Liu, Iwashyna, Brunkhorst, Rea et al., Assessment of clinical criteria for sepsis: For the third international consensus definitions for sepsis and septic shock (Sepsis-3), JAMA
Touafchia, Bagheri, Carrié, Durrieu, Sommet et al., Serious bradycardia and remdesivir for coronavirus 2019 (COVID-19): A new safety concerns, Clin Microbiol Infect
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Late treatment
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