From the Department of Pharmacy, University of Wisconsin Health, Madison, Wisconsin.
Division of Pediatric Critical Care Medicine.
Pediatr Infect Dis J. 2023 Apr 1;42(4):310-314. doi: 10.1097/INF.0000000000003814. Epub 2022 Dec 29.
Millions of children in the United States have been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with many infections leading to hospitalization. For pediatric patients, especially younger children, treatment options are limited. Remdesivir has demonstrated a positive safety and efficacy profile in adults, but little data is published regarding remdesivir use in pediatric patients. Additional data for SARS-CoV-2 treatments in pediatric patients is required to prevent further SARS-CoV-2-related morbidity and mortality. At a single pediatric academic medical center, the safety and efficacy of remdesivir was evaluated.
A retrospective review of patients admitted to a pediatric academic medical center who received remdesivir over a 17-month period was completed. All pediatric patients who received at least 1 dose of remdesivir were included. Safety and efficacy were assessed using national organization's definitions of clinical improvement, bradycardia, hypertension, acute kidney injury and drug-induced liver injury.
There were 48 pediatric patients included in this study with 29% of patients admitted to the pediatric intensive care unit. Less than one-third of patients received the full treatment course of remdesivir, with over half of patients not completing therapy due to symptomatic improvement or hospital discharge. Majority of patients required some level of supplemental oxygen support. The median World Health Organization score was consistent throughout all 5 days of therapy. No patients experienced significant bradycardia, hypertension, acute kidney injury, or drug-induced liver injury.
Remdesivir may correlate with clinical stability or improvement and demonstrates safety when used in pediatric patients. A randomized controlled trial is needed to confirm these findings.
美国有数百万儿童感染了严重急性呼吸综合征冠状病毒 2（SARS-CoV-2），许多感染导致住院。对于儿科患者，尤其是年幼的儿童，治疗选择有限。瑞德西韦已在成人中显示出积极的安全性和疗效，但关于儿科患者使用瑞德西韦的数据很少发表。需要更多关于 SARS-CoV-2 治疗儿科患者的数据，以防止进一步的 SARS-CoV-2 相关发病率和死亡率。在一家儿科学术医疗中心，评估了瑞德西韦的安全性和疗效。
对在过去 17 个月内接受瑞德西韦治疗的儿科学术医疗中心住院的患者进行了回顾性研究。所有接受至少 1 剂瑞德西韦治疗的儿科患者均被纳入研究。使用国家组织定义的临床改善、心动过缓、高血压、急性肾损伤和药物性肝损伤来评估安全性和疗效。
本研究共纳入 48 例儿科患者，其中 29%的患者被收入儿科重症监护病房。不到三分之一的患者接受了瑞德西韦的完整疗程治疗，超过一半的患者因症状改善或出院而未完成治疗。大多数患者需要某种程度的补充氧气支持。所有 5 天治疗过程中，世界卫生组织的中位数评分均保持一致。没有患者出现明显的心动过缓、高血压、急性肾损伤或药物性肝损伤。
瑞德西韦可能与临床稳定或改善相关，并在儿科患者中显示出安全性。需要进行随机对照试验来证实这些发现。
