Removal of Remdesivir's Metabolite GS-441524 by Hemodialysis in a Double Lung Transplant Recipient with COVID-19

Antimicrob Agents Chemother. 2020 Oct 20;64(11):e01521-20. doi: 10.1128/AAC.01521-20. Print 2020 Oct 20.

Abstract

Remdesivir has reported efficacy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro and in vivo Drug-drug interactions limit therapeutic options in transplant patients. Remdesivir and its metabolite GS-441524 are excreted principally in urine. In intensive care unit (ICU) settings, in which multiple-organ dysfunctions can occur rapidly, hemodialysis may be a viable option for maintaining remdesivir treatment, while improving tolerance, by removing both remdesivir's metabolite (GS-441524) and sulfobutylether β-cyclodextrin sodium (SEBCD). Additional studies may prove informative, particularly in the evaluations of therapeutic options for coronavirus disease 2019 (COVID-19).

Keywords: hemodialysis; pharmacokinetics; remdesivir.

MeSH terms

  • Adenosine Monophosphate / administration & dosage
  • Adenosine Monophosphate / adverse effects
  • Adenosine Monophosphate / analogs & derivatives*
  • Adenosine Monophosphate / chemistry
  • Adenosine Monophosphate / metabolism
  • Alanine / administration & dosage
  • Alanine / adverse effects
  • Alanine / analogs & derivatives*
  • Alanine / chemistry
  • Alanine / metabolism
  • Antiviral Agents / administration & dosage*
  • Antiviral Agents / adverse effects
  • Antiviral Agents / chemistry
  • Antiviral Agents / metabolism
  • Betacoronavirus / drug effects*
  • COVID-19
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / surgery
  • Coronavirus Infections / therapy*
  • Coronavirus Infections / virology
  • Drug Interactions
  • Furans / adverse effects
  • Furans / chemistry
  • Furans / urine*
  • Humans
  • Intensive Care Units
  • Lung Transplantation
  • Multiple Organ Failure
  • Pandemics
  • Pneumonia, Viral / surgery
  • Pneumonia, Viral / therapy*
  • Pneumonia, Viral / virology
  • Pyrroles / adverse effects
  • Pyrroles / chemistry
  • Pyrroles / urine*
  • Renal Dialysis
  • SARS-CoV-2
  • Transplant Recipients
  • Triazines / adverse effects
  • Triazines / chemistry
  • Triazines / urine*
  • beta-Cyclodextrins / adverse effects
  • beta-Cyclodextrins / chemistry
  • beta-Cyclodextrins / urine*

Substances

  • Antiviral Agents
  • Furans
  • Pyrroles
  • Triazines
  • beta-Cyclodextrins
  • GS-441524
  • SBE4-beta-cyclodextrin
  • remdesivir
  • Adenosine Monophosphate
  • Alanine

Supplementary concepts

  • COVID-19 drug treatment