Clinical safety of remdesivir therapy in COVID-19 patients with renal insufficiency.

Abstract

Though remdesivir benefits COVID-19 patients, its use in those with renal dysfunction is currently limited due to concerns about possible toxic effects of accumulated sulfobutylether-β-cyclodextrin (SBECD) on liver and kidney. We examined renal and hepatic function for a month in renally-impaired COVID-19 patients who were treated or not treated with remdesivir to assess the safety of the drug. A retrospective study was performed in adult COVID-19 patients with glomerular filtration rates of <30 ml/min/1.73 m2 at admission to a tertiary care hospital between November 2020 and March 2022. Data on serum creatinine and liver chemistry were collected serially. A total of 101 patients with impaired renal function were analyzed, comprising 64 remdesivir-treated patients and 37 who did not receive any antiviral agent. Although remdesivir-treated patients were more likely to be infected with the Omicron variant (79.7% vs. 48.6%), baseline characteristics did not differ significantly between the two groups. Among patients who initially did not require dialysis, 18.4% (7/38) of remdesivir-treated patients developed acute kidney injury (AKI) at days 4-6, compared with 51.7% (15/29) of non-remdesivir-treated patients. Liver injury severity worsened in 3.1% (2/64) of remdesivir-treated patients and 5.4% (2/37) of non-remdesivir-treated patients at days 4-6. In addition, there was no significant increase in AKI and liver injury over time in remdesivir-treated patients, and there were no cases of discontinuation of remdesivir due to adverse reactions. Concerns regarding the safety of SBECD should not lead to hasty withholding of remdesivir treatment in renally-impaired COVID-19 patients.

• Authors: Somi Park, A Reum Kim, Jiyoung Lee, Sung-Woon Kang, Heungsup Sung, Mi-Na Kim, Euijin Chang, Seongman Bae, Jiwon Jung, Min Jae Kim, Sung-Han Kim, Sang-Oh Lee, Sang-Ho Choi, Yang Soo Kim, Eun Hee Song, Yong Pil Chong
• Journal: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy (J Infect Chemother) Vol. 30 Issue 4 Pg. 366-370 (Apr 2024) ISSN: 1437-7780 [Electronic] Netherlands
• PMID: 37935348 (Publication Type: Journal Article)
• Copyright: Copyright © 2024 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.

Chemical References

• remdesivir
• Adenosine Monophosphate
• Alanine

Topics

• Adult
• Humans
• COVID-19
• SARS-CoV-2
• Retrospective Studies
• COVID-19 Drug Treatment
• Acute Kidney Injury (chemically induced, epidemiology)
• Adenosine Monophosphate (analogs & derivatives)
• Alanine (analogs & derivatives)