Remdesivir therapy has been declared as efficient in the early stages of Covid-19. Of the 339 patients (males 55.8%, age 71(59;77) years) with a detectable viral load, 140 were treated with remdesivir (of those 103 in the ICU and 57 immunosuppressed) and retrospectively compared with 199 patients (of those 82 in the ICU and 28 immunosuppressed) who were denied therapy due to advanced Covid-19. The viral load was estimated by detecting nucleocapsid antigen in serum (n = 155, median 217(28;1524)pg/ml), antigen in sputum (n = 18, COI 18(4.6;32)), nasopharyngeal antigen (n = 44, COI 17(8;35)) and the real-time PCR (n = 122, Ct 21(18;27)). After adjustment for confounders, patients on remdesivir had better 12-month survival (HR 0.66 (0.44;0.98), p = 0.039), particularly when admitted to the ICU (HR 0.49 (0.29;0.81), p = 0.006). For the immunocompromised patients, the difference did not reach statistical significance (HR 0.55 (0.18;1.69), p = 0.3). The other most significant confounders were age, ICU admission, mechanical ventilation, leukocyte/lymphocyte ratio, admission creatinine and immunosuppression. The impact of monoclonal antibodies or previous vaccinations was not significant. Despite frequent immune suppression including haemato-oncology diseases, lymphopenia, and higher inflammatory markers in the remdesivir group, the results support remdesivir administration with respect to widely available estimates of viral load in patients with high illness severity.

Department of Anaesthesiology and Intensive Care 1st Faculty of Medicine Charles University and General University Hospital Prague U Nemocnice 2 Prague 2 Prague 12800 Czech Republic

Department of Anaesthesiology and Intensive Care 3rd Faculty of Medicine Charles University and Kralovske Vinohrady University Hospital Prague Prague Czech Republic

Department of Laboratory Diagnostics 3rd Faculty of Medicine Charles University and Kralovske Vinohrady University Hospital Prague Prague Czech Republic

Department of Microbiology Faculty of Medicine and Dentistry Palacky University Olomouc Czech Republic

Faculty of Medicine Institute of Health Information and Statistics of the Czech Republic Masaryk University Brno Czech Republic

Institute of Medical Biochemistry and Laboratory Diagnostics 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Zobrazit více v PubMed

Amstutz, A. PubMed DOI PMC

Beigel, J. H. PubMed DOI PMC

Frediansyah, A., Nainu, F., Dhama, K., Mudatsir, M. & Harapan, H. Remdesivir and its antiviral activity against COVID-19: A systematic review. PubMed DOI PMC

Gottlieb, R. L. PubMed DOI PMC

Spinner, C. D. PubMed DOI PMC

Alonso-Navarro, R. PubMed DOI PMC

Ader, F. PubMed DOI PMC

Akiyama, S., Hamdeh, S., Micic, D. & Sakuraba, A. Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: A systematic review and meta-analysis. PubMed DOI

Lee, L. Y. W. PubMed DOI PMC

Pablos, J. L. PubMed DOI

Passamonti, F. PubMed DOI PMC

Ali, K. PubMed DOI PMC

Garibaldi, B. T. PubMed DOI PMC

Grasselli, G. PubMed DOI PMC

Pan, H. PubMed DOI PMC

Adamsick, M. L. PubMed DOI PMC

Aiswarya, D. PubMed DOI PMC

Cillóniz, C. PubMed DOI PMC

Goldberg, E. PubMed PMC

Marrone, A. PubMed DOI PMC

Bauer, R. N. PubMed DOI PMC

Bergwerk, M. PubMed DOI PMC

Lingas, G. PubMed DOI PMC

Bermejo-Martin, J. F. PubMed DOI PMC

Jittamala, P. PubMed DOI PMC

Pujadas, E. PubMed DOI PMC

Drain, P. K. Rapid diagnostic testing for SARS-CoV-2. PubMed DOI PMC

Singanayagam, A. PubMed DOI PMC

Marks, M. PubMed DOI PMC

La Scola, B. PubMed DOI PMC

Corman, V. M. PubMed DOI PMC

Corey, L. PubMed DOI PMC

Frampton, D. PubMed DOI PMC

Ong, S. W. X. PubMed DOI PMC

Benotmane, I. PubMed DOI PMC

Benotmane, I., Risch, S., Doderer-Lang, C., Caillard, S. & Fafi-Kremer, S. Long-term shedding of viable SARS-CoV-2 in kidney transplant recipients with COVID-19. PubMed DOI PMC

Lahmer, T. PubMed DOI PMC

Razzack, A. A. PubMed DOI PMC

Ryoo, S. PubMed DOI PMC

Marshall, J. C. PubMed DOI PMC

Team, R.C. A language and environment for statistical computing in https://www.R-project.org (ed. Computing, R.F.f.S.) (Vienna, 2022).

team, P. RStudio: integrated development environment for R. Posit Software. in http://www.posit.co, Vol. 2022 (ed. PBC) (Boston, MA, 2022).

Simon, N., Friedman, J., Hastie, T. & Tibshirani, R. Regularization paths for Cox’s proportional hazards model via coordinate descent. PubMed DOI PMC

Stekhoven, D. J. & Bühlmann, P. MissForest–non-parametric missing value imputation for mixed-type data. PubMed DOI

Magleby, R. PubMed DOI PMC

Mair, M. J. PubMed DOI PMC

Stephens, D. S. & McElrath, M. J. COVID-19 and the path to immunity. PubMed DOI PMC

RECOVERY Collaborative Group. Casirivimab and imdevimab in patients admitted to hospital with COVID-19 (RECOVERY): A randomised, controlled, open-label, platform trial. PubMed DOI PMC

Fourati, S., Hue, S., Pawlotsky, J. M., Mekontso-Dessap, A. & de Prost, N. SARS-CoV-2 viral loads and serum IgA/IgG immune responses in critically ill COVID-19 patients. PubMed DOI PMC

Rogers, A. J. PubMed DOI PMC

Westblade, L. F. PubMed DOI PMC

Ma, Q. PubMed DOI PMC

Liu, W. PubMed DOI PMC

Drain, P. K. PubMed DOI PMC

Congly, S. E., Varughese, R. A., Brown, C. E., Clement, F. M. & Saxinger, L. Treatment of moderate to severe respiratory COVID-19: A cost-utility analysis. PubMed DOI PMC

Lau, V. I. PubMed DOI PMC

Wong, C. K. H. PubMed DOI PMC

The impact of remdesivir on renal and liver functions in severe COVID-19 patients with presence of viral load