Division of Infectious Diseases, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Korean Med Sci. 2021 Mar 22;36(11):e83. doi: 10.3346/jkms.2021.36.e83.
Remdesivir is widely used for the treatment of coronavirus disease 2019 (COVID-19), but controversies regarding its efficacy still remain.
A retrospective cohort study was conducted to evaluate the effect of remdesivir on clinical and virologic outcomes of severe COVID-19 patients from June to July 2020. Primary clinical endpoints included clinical recovery, additional mechanical ventilator (MV) support, and duration of oxygen or MV support. Viral load reduction by hospital day (HD) 15 was evaluated by calculating changes in cycle threshold (Ct) values.
A total of 86 severe COVID-19 patients were evaluated including 48 remdesivir-treated patients. Baseline characteristics were not significantly different between the two groups. Remdesivir was administered an average of 7.42 days from symptom onset. The proportions of clinical recovery of the remdesivir and supportive care group at HD 14 (56.3% and 39.5%) and HD 28 (87.5% and 78.9%) were not statistically different. The proportion of patients requiring MV support by HD 28 was significantly lower in the remdesivir group than in the supportive care group (22.9% vs. 44.7%, = 0.032), and MV duration was significantly shorter in the remdesivir group (average, 1.97 vs. 5.37 days; = 0.017). Analysis of upper respiratory tract specimens demonstrated that increases of Ct value from HD 1-5 to 11-15 were significantly greater in the remdesivir group than the supportive care group (average, 10.19 vs. 5.36; = 0.007), and the slope of the Ct value increase was also significantly steeper in the remdesivir group (average, 5.10 vs. 2.68; = 0.007).
The remdesivir group showed clinical and virologic benefit in terms of MV requirement and viral load reduction, supporting remdesivir treatment for severe COVID-19.
瑞德西韦广泛用于治疗 2019 年冠状病毒病（COVID-19），但其疗效仍存在争议。
回顾性队列研究评估了 2020 年 6 月至 7 月期间瑞德西韦对重症 COVID-19 患者的临床和病毒学结局的影响。主要临床终点包括临床康复、额外的机械通气（MV）支持以及氧疗或 MV 支持的持续时间。通过计算 Ct 值的变化来评估住院第 15 天（HD）时的病毒载量降低。
共评估了 86 例重症 COVID-19 患者，其中 48 例接受了瑞德西韦治疗。两组患者的基线特征无显著差异。瑞德西韦从发病到开始治疗的平均时间为 7.42 天。瑞德西韦组和支持性治疗组在 HD14 时的临床康复率（56.3%和 39.5%）和 HD28 时的临床康复率（87.5%和 78.9%）无统计学差异。瑞德西韦组在 HD28 时需要 MV 支持的患者比例明显低于支持性治疗组（22.9%比 44.7%， = 0.032），且瑞德西韦组的 MV 持续时间明显短于支持性治疗组（平均，1.97 比 5.37 天； = 0.017）。对上呼吸道标本的分析表明，从 HD1-5 到 HD11-15 时，Ct 值的增加在瑞德西韦组比支持性治疗组更明显（平均，10.19 比 5.36； = 0.007），且瑞德西韦组 Ct 值增加的斜率也明显更陡（平均，5.10 比 2.68； = 0.007）。
瑞德西韦组在 MV 需求和病毒载量降低方面显示出临床和病毒学获益，支持瑞德西韦治疗重症 COVID-19。
