基于倾向性评分匹配的瑞德西韦治疗伴肾功能损害的 COVID-19 患者的安全性和有效性分析。

Propensity score matched analysis for the safety and effectiveness of remdesivir in COVID-19 patients with renal impairment.

机构信息

Division of Infectious Disease, Seoul Medical Center, 156, Sinnae-Ro, Jungnang-Gu, Seoul, 05505, Republic of Korea.

Department of Emergency Medicine, KyungHee University Hospital at Gangdong, Seoul, South Korea.

出版信息

BMC Infect Dis. 2024 Jan 2;24(1):3. doi: 10.1186/s12879-023-08859-9.

DOI:10.1186/s12879-023-08859-9

PMID:38166787

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10759744/

Abstract

BACKGROUNDS

Remdesivir (RDV) is an antiviral agent approved for the treatment of coronavirus disease 2019 (COVID-19); however, is not recommended for patients with renal impairment. Due to limitations associated with prospective clinical trials, real-world data on the safety and efficacy of RDV in patients with renal impairment are necessary.

METHODS

Propensity score-matched (PSM) retrospective analysis was conducted between March 2020 and September 2022 in COVID-19 patients with an eGFR < 30 mL/min in four Korean hospitals. The RDV treatment group was matched to the untreated control group. The safety and clinical outcomes in patients who received RDV were analyzed.

RESULTS

A total of 564 patients were enrolled; 229 patients received RDV either for treatment or prophylaxis. On day 5, no difference in nephrotoxicity was observed between the two groups, and liver enzyme levels were within the normal range. In multivariate analysis for new dialysis, RDV treatment was not a risk factor for new dialysis. Among the 564 patients, 417 were indicated for a 5-day course of RDV treatment and 211 patients were treated with RDV. After PSM, no differences in the clinical outcomes were observed between the two groups.

CONCLUSION

RDV use in COVID-19 patients with renal impairment did not result in significant nephrotoxicity or hepatotoxicity.

摘要

背景

瑞德西韦（RDV）是一种已获批准用于治疗 2019 年冠状病毒病（COVID-19）的抗病毒药物；然而，不建议用于肾功能受损的患者。由于与前瞻性临床试验相关的限制，有必要在肾功能受损的 COVID-19 患者中获取关于 RDV 的安全性和疗效的真实世界数据。

方法

在 2020 年 3 月至 2022 年 9 月期间，在韩国的四家医院中，对 eGFR<30 mL/min 的 COVID-19 患者进行了倾向评分匹配（PSM）回顾性分析。将 RDV 治疗组与未治疗的对照组进行匹配。分析了接受 RDV 治疗的患者的安全性和临床结局。

结果

共纳入 564 例患者；229 例患者接受了 RDV 的治疗或预防。在第 5 天，两组之间未观察到肾毒性差异，且肝酶水平在正常范围内。在新透析的多变量分析中，RDV 治疗不是新透析的危险因素。在 564 例患者中，417 例患者的 RDV 治疗疗程为 5 天，211 例患者接受了 RDV 治疗。在 PSM 后，两组之间的临床结局无差异。