Early experience with remdesivir in SARS-CoV-2 pneumonia

• Published in: Infection Vol. 48; no. 5; pp. 779 - 782
• Main Authors: Durante-Mangoni, Emanuele, Andini, Roberto, Bertolino, Lorenzo, Mele, Ferruccio, Florio, Letizia Lucia, Murino, Patrizia, Corcione, Antonio, Zampino, Rosa
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2020
• Subjects: Adenosine Monophosphate - administration & dosage; Adenosine Monophosphate - adverse effects; Adenosine Monophosphate - analogs & derivatives; Alanine - administration & dosage; Alanine - adverse effects; Alanine - analogs & derivatives; Antiviral Agents - administration & dosage; Antiviral Agents - adverse effects; Betacoronavirus - drug effects; Betacoronavirus - immunology; Case Report; Chemical and Drug Induced Liver Injury - diagnosis; Chemical and Drug Induced Liver Injury - etiology; Chemical and Drug Induced Liver Injury - physiopathology; Chemical and Drug Induced Liver Injury - virology; Convalescence; Coronavirus Infections - drug therapy; Coronavirus Infections - virology; COVID-19; Critical Illness; Darunavir - administration & dosage; Darunavir - adverse effects; Drug Administration Schedule; Drug Combinations; Family Medicine; Fatal Outcome; General Practice; Humans; Hydroxychloroquine - administration & dosage; Hydroxychloroquine - adverse effects; Infectious Diseases; Internal Medicine; Lopinavir - administration & dosage; Lopinavir - adverse effects; Medicine; Medicine & Public Health; Multiple Organ Failure - chemically induced; Multiple Organ Failure - diagnosis; Multiple Organ Failure - physiopathology; Multiple Organ Failure - virology; Pandemics; Pneumonia, Viral - drug therapy; Pneumonia, Viral - virology; Ritonavir - administration & dosage; Ritonavir - adverse effects; RNA, Viral - blood; SARS-CoV-2; Torsades de Pointes - chemically induced; Torsades de Pointes - diagnosis; Torsades de Pointes - physiopathology; Torsades de Pointes - virology; SARS-CoV-2; Pneumonia; Antiviral therapy; Remdesivir; COVID 19
• ISSN: 0300-8126; 1439-0973; 1439-0973
• DOI: 10.1007/s15010-020-01448-x

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.