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Respiratory Diseases
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Aref T. Senno, Ryan K. Brannon
Remdesivir is an IV prodrug of an adenosine analog, which binds the viral RNA-dependent RNA polymerase to inhibit replication. Remdesivir is available through Emergency Use Authorization (EUA) by the FDA and supply is limited globally. A large RCT identified shorter time to clinical recovery compared to placebo (11 days vs. 15 days) [158]. A post-hoc analysis suggested that there may be a survival benefit for this group. When supplementary oxygen is required via a high-flow device, non-invasive ventilation, or invasive mechanical ventilation, Remdesivir should only be administered in combination with dexamethasone and not as mono-therapy. Optimal duration of treatment is not clear, though 5 and 10-day courses have been proposed. Gastrointestinal side effects including nausea, vomiting and diarrhea are most common. Dosing is suggested at 200 mg IV over 30–120 minutes for 1 dose, followed by 100 mg IV on day 2 onwards. Transaminase elevations may occur. Additionally, PT prolongation may occur. The drug vehicle, SBECD may cause renal toxicity. Both liver and renal function tests should be collected prior to initiation of therapy and should be evaluated during the treatment course.
An Overview of COVID-19 Treatment
Published in Hanadi Talal Ahmedah, Muhammad Riaz, Sagheer Ahmed, Marius Alexandru Moga, The Covid-19 Pandemic, 2023
Saffora Riaz, Farkhanda Manzoor, Dou Deqiang, Najmur Rahman
Remdesivir may be recommended for hospitalized COVID-19 patients because of its clinical benefit recovery and improvement in patients. A simple prodrug remdesivir has substantial clinical advantages, expected fruitful fundamental outcomes dependent on its delivered beneficial results [47]. General mortality is the main endpoint result of any preliminary clinical trials; advanced remdesivir caused do not show a satisfactory reduction in mortality [48]. Regardless of all analysis and alerts, the FDA has endorsed remdesivir to be utilized for COVID-19. Therefore, remdesivir advised against COVID-19 with mild infection [49, 50].
Drug Repurposing and Novel Antiviral Drugs for COVID-19 Management
Published in Debmalya Barh, Kenneth Lundstrom, COVID-19, 2022
Shailendra Dwivedi, Aakanksha Rawat, Amit Ranjan, Ruchika Agrawal, Radhieka Misra, Sunil Kumar Gupta, Surekha Kishore, Sanjeev Misra
The effect of Remedesivir was studied from March 21 to June 16, 2020 in 86 hospitalized pregnant women who had confirmed diagnosis (Real-Time PCR) of COVID-19. Remdesivir treatment was provided for 10 days (200 mg on day 1, followed by 100 mg for days 2–10, given intravenously). After 28 days of follow-up, the level of oxygen necessity decreased in 96% of pregnant women. Of pregnant women who were on mechanical ventilation, 93% were extubated, 93% recovered, and 90% were discharged. Remdesivir was well tolerated, with no severe complication of adverse events (AEs) [15].
Assessment of adverse events associated with remdesivir use for coronavirus disease 2019 using real-world data
Published in Expert Opinion on Drug Safety, 2021
The most common adverse events reported with remdesivir use belonged to the hepatic and renal systems, elevation of liver enzymes and acute kidney injury, respectively; Table 3 shows the most frequently reported adverse events associated with remdesivir use. A disproportionality analysis was carried out to compare the reporting of adverse events with or without remdesivir as a suspect medication. Elevation of liver enzymes, acute kidney injury and renal abnormalities, bradycardia, cardiac arrest, and death in association with remdesivir use had significantly higher reporting (ROR lower 95% CI >1) compared with other drugs in the database. While there were 108 reports of ‘glomerular filtration rate decreased’ with remdesivir use, no such cases were reported with other drugs. The disproportionality results for all adverse event terms with reporting frequency ≥100 in the FAERS database are shown in Figure 1.
On the molecular structure of Remdesivir for the treatment of Covid-19
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
S. M. Sheikholeslami, A. Jahanbani, Z. Shao
These preliminary findings support the use of remdesivir for patients who are hospitalized with Covid-19 and require supplemental oxygen therapy. However, given high mortality despite the use of remdesivir, it is clear that treatment with an antiviral drug alone is not likely to be sufficient. Future strategies should evaluate antiviral agents in combination with other therapeutic approaches or combinations of antiviral agents to continue to improve patient outcomes in Covid-19. On May 1, the U.S Food and Drug Administration issued an emergency use authorization of remdesivir, an experimental anti-viral drug. With this clearance, doctors in the U.S. are now allowed to use the drug to treat patients with severe cases of COVID-19. Remdesivir isn’t new. It was initially developed to treat Ebola and was also tested in the lab against SARS and MERS-two other coronaviruses that infect humans much like the virus that causes COVID-19. Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to spread rapidly across China (Huang et al. 2020). As of 7 March 2020, the infection was reported from 97 countries globally. To date, 103,882 patients have been confirmed to have COVID-19, of whom 3522 have died (Xu 2020).
Hepatic manifestations of COVID-19 and effect of remdesivir on liver function in patients with COVID-19 illness
Published in Baylor University Medical Center Proceedings, 2021
Abdul Aleem, Guruprasad Mahadevaiah, Nasir Shariff, Jiten P. Kothadia
Coronavirus disease 2019 (COVID-19), the illness caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), has emerged as the most significant global health crisis since the influenza pandemic of 1918. SARS-CoV-2 is a novel beta coronavirus belonging to the same subgenus as the severe acute respiratory syndrome (SARS-CoV) virus and Middle East respiratory syndrome coronavirus (MERS-CoV). It has a case fatality rate of 2.3% compared to 9.5% and 34.4% for SARS-CoV and MERS-CoV, respectively.1 A meta-analysis of 50 studies reported that patients of Black and Asian ethnic minority groups are at increased risk of contracting SARS-CoV-2 infection compared with White patients.2 The respiratory system is the primary organ system affected; however, COVID-19 is also frequently associated with the elevation of liver biochemistries in patients with or without clinical symptoms. Remdesivir is a broad-spectrum antiviral agent that is approved by the US Food and Drug Administration (FDA) for hospitalized patients with COVID-19. In this systematic review, we aim to present the latest data on hepatic manifestations of COVID-19 infection and the efficacy and potential hepatoxicity associated with remdesivir. We performed a literature search using Google Scholar and PubMed from January 2020 to October 2020 for studies describing hospitalized patients with COVID-19 who received remdesivir therapy.