Remdesivir has been found to be an in-vitro potent inhibitor of RNA viruses including SARS-CoV-2 but its in-vivo potency is still under active investigations.
•In this work, we depict the clinical features of 5 hospitalized COVID-19 patients under remdisivir compassionate use.
•Remdisivir infusion was associated with decreasing viral loads from nasopharyngeal samples despite active replication in the lower respiratory tract area evidenced for two patients.
•The treatment had to be interrupted for potential side effects for 4 out 5 patients including two alamine aminotransferase (ALT) elevation and two renal failure cases.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been identified as responsible for the COVID-19 outbreak worldwide. Data on treatment are scare and parallels are made between SARS-CoV-2 and other coronavirus. Remdesivir is a broad spectrum antiviral with efficient in vitro activity against SARS-CoV-2 and controversial evidence of clinical improvement in severe COVID-19 patients. We aimed to describe the clinical outcome and virological monitoring of the first five COVID-19 patients admitted in ICU for severe pneumonia related to SARS-CoV-2 and treated with remdesivir in the University hospital of Bichat, Paris, France.
SARS-CoV-2 RT-qPCR in blood plasma, lower and upper respiratory tract were monitored. Among the five treated patients, two needed mechanical ventilation and one high flow cannula oxygen. A significant decrease in SARS-CoV-2 viral load from upper respiratory tract was observed in most cases but two died with active SARS-CoV-2 replication in the lower respiratory tract. Plasma samples were positive for SARS-CoV-2 in only one patient. Remdesivir was interrupted for side effects among four patients, including 2 ALT elevations (3 to 5 N) and 2 renal failures requiring renal replacement.
This case series of five COVID-19 patients requiring ICU for a respiratory distress and treated with remdesivir, highlights the complexity of remdesivir use in such critically ill patients.
Human immunodeficiency virus 1
SARS-CoV-2severe acute respiratory syndrome coronavirus 2
SARS-CoV-2 viral load
remdesivir
antiviral therapy
viral pneumonia
case reports
View Abstract© 2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.