Department of Infectious Diseases, Sahlgrenska University Hospital, Diagnosvagen 21, 416 50 Gothenburg, Sweden.
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
J Antimicrob Chemother. 2023 Nov 6;78(11):2735-2742. doi: 10.1093/jac/dkad295.
Studies on the antiviral effects of remdesivir have shown conflicting results. SARS-CoV-2 viraemia could identify patients in whom antiviral treatment may be particularly beneficial.
To investigate antiviral effects and clinical outcomes of remdesivir treatment in viraemic patients.
Viraemic patients hospitalized for COVID-19 with ratio of arterial oxygen partial pressure to fractional inspired oxygen of ≤300, symptom duration ≤10 days, and estimated glomerular filtration rate ≥30 mL/min were included in a cohort. The rate of serum viral clearance and serum viral load decline, 60 day mortality and in-hospital outcomes were estimated. A subgroup analysis including patients with symptom duration ≤7 days was performed.
A total of 318 viraemic patients were included. Thirty-three percent (105/318) received remdesivir. The rate of serum viral clearance [subhazard risk ratio (SHR) 1.4 (95% CI 0.9-2.0), P = 0.11] and serum viral load decline (P = 0.11) were not significantly different between remdesivir-treated patients and controls. However, the rate of serum viral clearance was non-significantly higher [SHR 1.6 (95% CI 1.0-2.7), P = 0.051] and the viral load decline was faster (P = 0.03) in remdesivir-treated patients with symptom duration ≤7 days at admission. The 60 day mortality [HR 1.0 (95% CI 0.6-1.8), P = 0.97] and adverse in-hospital outcomes [OR 1.4 (95% CI 0.8-2.4), P = 0.31] were not significantly different between remdesivir-treated patients and controls.
Remdesivir treatment did not significantly change the duration of SARS-CoV-2 viraemia, decline of serum viral load, 60 day mortality or in-hospital adverse outcomes in patients with ≤10 days of symptoms at admission. Remdesivir appeared to reduce the duration of viraemia in a subgroup of patients with ≤7 days of symptoms at admission.
关于瑞德西韦抗病毒作用的研究结果存在矛盾。SARS-CoV-2 病毒血症可识别出可能从抗病毒治疗中获益的患者。
探讨瑞德西韦治疗病毒血症患者的抗病毒效果和临床结局。
纳入因 COVID-19 住院且动脉血氧分压与吸入氧分数比≤300、症状持续时间≤10 天且估算肾小球滤过率≥30 mL/min 的病毒血症患者进行队列研究。评估血清病毒清除率和血清病毒载量下降率、60 天死亡率和住院结局。对包括症状持续时间≤7 天的患者的亚组进行分析。
共纳入 318 例病毒血症患者。33%（105/318）接受了瑞德西韦治疗。与对照组相比，瑞德西韦治疗组的血清病毒清除率（亚危险比 1.4（95%可信区间 0.9-2.0），P=0.11）和血清病毒载量下降率（P=0.11）差异无统计学意义。然而，入院时症状持续时间≤7 天的瑞德西韦治疗患者的血清病毒清除率非显著升高（亚危险比 1.6（95%可信区间 1.0-2.7），P=0.051），病毒载量下降更快（P=0.03）。瑞德西韦治疗组与对照组相比，60 天死亡率（HR 1.0（95%可信区间 0.6-1.8），P=0.97）和住院不良结局（OR 1.4（95%可信区间 0.8-2.4），P=0.31）差异无统计学意义。
在入院症状持续时间≤10 天的患者中，瑞德西韦治疗并未显著改变 SARS-CoV-2 病毒血症持续时间、血清病毒载量下降、60 天死亡率或住院不良结局。瑞德西韦似乎可以缩短入院时症状持续时间≤7 天的患者的病毒血症持续时间。
