Early experience with remdesivir in SARS-CoV-2 pneumonia

Abstract

At present, there is no definitive antiviral treatment for coronavirus disease 2019 (COVID-19). We describe our early experience with remdesivir in four critically ill COVID-19 patients. Patients received a 200 mg loading dose, followed by 100 mg daily intravenously for up to 10 days. All patients had been previously treated with other antivirals before remdesivir initiation. One patient experienced a torsade de pointes requiring cardiac resuscitation and one died due to multiple organ failure. Three patients showed biochemical signs of liver injury. Lymphocyte count increased in all patients soon after remdesivir initiation. Nasal swab SARS-CoV-2 RNA became negative in three of four patients after 3 days of therapy. We observed an in vivo virological effect of remdesivir in four critically ill, COVID-19 patients, coupled with a significant burden of adverse events. Although limited by the low number of subjects studied, our preliminary experience may be relevant for clinicians treating COVID-19.

Keywords: Antiviral therapy; COVID 19; Pneumonia; Remdesivir; SARS-CoV-2.

Fig. 1

Dynamics of C-reactive protein (CRP), lymphocyte count and ratio between partial oxygen pressure (PaO2) and inspired fraction of oxygen (FiO2) in the four patients treated with remdesivir. Antiviral agents administered are shown in the colored boxes for the pertinent time of therapy. The results of SARS-CoV-2 RNA testing on nasal swabs are shown with + and - signs. Time of ICU stay is shown by the blue bar. Changes in major acute physiology and organ function assessment scores before and after remdesivir administration are also shown. LPV/r, lopinavir/ritonavir; DRV/c, darunavir/cobicistat; HCQ, hydroxychloroquine; RDV, remdesivir; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; APACHE, Acute Physiology and Chronic Health Evaluation Score; PSI, pulmonary severity index; MODS, Multiple Organ Dysfunction Score