Terkes Vedrana, Lisica Karla, Marusic Martina, Verunica Nikola, Tolic Anela, Morovic Miro
Department of Infectious Diseases, Zadar General Hospital, 23000 Zadar, Croatia.
Emergency Department, Zadar General Hospital, 23000 Zadar, Croatia.
J Clin Med. 2022 Aug 29;11(17):5066. doi: 10.3390/jcm11175066.
Almost two years after remdesivir was approved and extensively used in numerous clinical studies for the treatment of COVID-19 patients, there is still no clear recommendation for the time and phase of the disease of remdesivir administration. This retrospective observational study included adults (≥18 years) with severe COVID-19, radiologically confirmed pneumonia, a need for supplemental oxygen and an interval from symptom onset to enrolment of 10 days or less. All patients were treated with remdesivir for 5 to 10 days, or with clinical improvement within that period. The primary goal was the outcome in patients treated with remdesivir during the early stage of the disease considering the different disease severity. The median time from symptom onset to treatment was 8.4 days (3−10). Clinical improvements and good outcomes were observed in 104 of 137 patients (75.9%); 33 (24.1%) of 137 patients died. Subgroup analyses showed that the mortality rate was significantly lower in moderately ill patients (3 out of 51 patients; 5.9%) than in the group of severely/critically ill patients (30 out of 86 patients; 34.8%; p < 0.005). Older age, rise of CRP and CT score were shown to be significant predictors of disease outcome. Overall, remdesivir was well tolerated, and the treatment was discontinued in only four patients. The results of this observational study in 137 patients with different disease severity contribute to the attitude concerning remdesivir administration in the early stage of COVID-19, at least in moderately ill patients with a high risk of progression, before the transition to a more severe stage.
在瑞德西韦被批准并广泛用于众多治疗新冠肺炎患者的临床研究近两年后，对于瑞德西韦给药的疾病时间和阶段仍没有明确的建议。这项回顾性观察性研究纳入了患有严重新冠肺炎、经影像学确诊为肺炎、需要补充氧气且症状出现至入组间隔为10天或更短时间的成年人（≥18岁）。所有患者接受瑞德西韦治疗5至10天，或在此期间临床症状改善。主要目标是考虑到不同疾病严重程度，观察疾病早期接受瑞德西韦治疗患者的结局。从症状出现到治疗的中位时间为8.4天（3 - 10天）。137例患者中有104例（75.9%）出现临床改善且预后良好；137例患者中有33例（24.1%）死亡。亚组分析显示，中度疾病患者（51例中有3例；5.9%）的死亡率显著低于重度/危重症患者组（86例中有30例；34.8%；p < 0.005）。年龄较大、CRP升高和CT评分被证明是疾病结局的显著预测因素。总体而言，瑞德西韦耐受性良好，仅4例患者停止治疗。这项对137例不同疾病严重程度患者的观察性研究结果有助于确定在新冠肺炎早期使用瑞德西韦的态度，至少对于有进展为更严重阶段高风险的中度疾病患者是如此。
