Alibrahim Rim S, Elmekaty Eman Z, Elmekaty Mohamed Z I, Edbais Mohammad, Alkhatib Mohammed, Daghfal Joanne, Almaslamani Muna A, Omrani Ali S
Department of Pharmacy, Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar E-mail:
Department of Pediatrics, Medical Education, Hamad Medical Corporation, Doha, Qatar.
Qatar Med J. 2022 Jun 16;2022(3):25. doi: 10.5339/qmj.2022.25. eCollection 2022.
Treatment options for patients with critical Coronavirus Disease 2019 (COVID-19) are limited. This study aimed to describe the clinical characteristics and outcomes associated with remdesivir therapy in patients with COVID-19 who require non-invasive (NIV) ventilation or invasive mechanical ventilation (IMV).
Data were retrospectively extracted for adults with COVID-19 confirmed using polymerase chain reaction (PCR) between August 1, 2020 and January 28, 2021 who received ≥ 48 hours of remdesivir therapy while on NIV or IMV. Clinical improvement was defined as two-category improvement on an eight-point ordinal severity scale.
A total of 133 individuals were included, of which 114 (85.7%) were on NIV and 19 (14.3%) were on IMV at the time of remdesivir initiation. The majority of the patients were males (62.4%), and the median age was 56 years. All the patients received concomitant dexamethasone therapy. Remdesivir treatment was commenced after a median of 7 days from onset of symptoms and was continued for a median of 5 days. Clinical improvement within 28 days was achieved in 101 patients (75.9%); among which, 78.1% and 63.2% were subjected to baseline NIV and IMV, respectively. Among the 11 (8.3%) patients who died of any cause by day 28, 9 (7.9%) and 2 (10.5%) were subjected to baseline NIV and IMV, respectively. The most frequent adverse events were sinus bradycardia (21, 13.1%) and alanine transaminase increase (18, 11.3%). Almost all adverse events were classified as Grades 1-3.
The use of remdesivir in combination with systemic corticosteroids is associated with high recovery rates and low all-cause mortality in patients with COVID-19 pneumonia who require NIV or IMV. The results need confirmation from clinical trials of appropriate design and size.
2019年冠状病毒病（COVID-19）危重症患者的治疗选择有限。本研究旨在描述接受瑞德西韦治疗的需要无创通气（NIV）或有创机械通气（IMV）的COVID-19患者的临床特征及治疗结果。
回顾性提取2020年8月1日至2021年1月28日期间，经聚合酶链反应（PCR）确诊为COVID-19的成年患者数据，这些患者在接受NIV或IMV治疗期间接受了≥48小时的瑞德西韦治疗。临床改善定义为在八分序贯严重程度量表上有两级改善。
共纳入133例患者，其中114例（85.7%）在开始使用瑞德西韦时接受NIV治疗，19例（14.3%）接受IMV治疗。大多数患者为男性（62.4%），中位年龄为56岁。所有患者均接受了地塞米松联合治疗。瑞德西韦治疗在症状出现后中位7天开始，中位持续5天。101例患者（75.9%）在28天内实现临床改善；其中，基线时接受NIV和IMV治疗的患者分别有78.1%和63.2%实现改善。在第28天因任何原因死亡的11例（8.3%）患者中，基线时接受NIV和IMV治疗的患者分别有9例（7.9%）和2例（10.5%）。最常见的不良事件为窦性心动过缓（21例，13.1%）和丙氨酸转氨酶升高（18例，11.3%）。几乎所有不良事件均为1-3级。
对于需要NIV或IMV的COVID-19肺炎患者，使用瑞德西韦联合全身糖皮质激素治疗可实现高恢复率和低全因死亡率。结果需要适当设计和规模的临床试验予以证实。
