Department of Cardiovascular, University of the Ryukyus Graduate School of Medicine, Nephrology, and Neurology, Okinawa, Japan.
Dialysis Unit, University of the Ryukyus Hospital, Okinawa, Japan.
Medicine (Baltimore). 2024 Nov 29;103(48):e40650. doi: 10.1097/MD.0000000000040650.
Although the mortality of severe coronavirus disease 2019 (COVID-19) has decreased after the emergence of the Omicron variant, it remains high in patients on hemodialysis (HD). Remdesivir (RDV) is considered as the first line drug for hospitalized COVID-19 patients, however the evidence regarding the usage in HD patients is lacking because clinical trials of RDV have excluded HD patients for safety reasons. Thus, accumulation of knowledge on the regimen, efficacy, and tolerability of RDV in HD patients is important.
A nosocomial COVID-19 cluster was occurred from August 31 to October 12 in 2021 when the Delta variant was predominant. During the cluster, 11 health-care workers and 20 inpatients including 7 HD patients were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
The diagnosis of COVID-19 was confirmed by the real-time polymerase chain reaction (PCR) for SARS-CoV-2.
RDV was initiated within 16 hours after the onset of fever (≥ 37.4°C) or positive PCR result in all HD patients, and continued at 100 mg/day intravenously once daily for either consecutive 5 or 10 days.
All patients fully recovered within 2 weeks and did not develop severe COVID-19. Two patients experienced mild liver dysfunction, but it was temporary and remitted spontaneously even continuing RDV treatment. Discontinuation of RDV therapy due to adverse events was not required in any patients.
Present cases indicated early intervention with RDV may contribute the favorable outcome and daily administration of RDV for up to 10 days was well tolerated even in HD patients. Literature review showed no previous article reported the efficacy and safety of such earlier and longer administration of remdesivir as in the present cases, therefore this report is informative for clinicians to consider the usage of RDV in HD patients.
尽管奥密克戎变异株出现后，严重 2019 冠状病毒病（COVID-19）的死亡率有所下降，但在接受血液透析（HD）的患者中仍然很高。瑞德西韦（RDV）被认为是住院 COVID-19 患者的一线药物，然而，由于 RDV 的临床试验出于安全原因排除了 HD 患者，因此缺乏关于 RDV 在 HD 患者中使用的证据。因此，积累关于 RDV 在 HD 患者中的方案、疗效和耐受性的知识非常重要。
德尔塔变异株占主导地位期间，2021 年 8 月 31 日至 10 月 12 日发生了一起医院内 COVID-19 聚集性疫情。在此期间，共有 11 名医护人员和 20 名住院患者（包括 7 名 HD 患者）感染了严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）。
COVID-19 的诊断通过实时聚合酶链反应（PCR）检测 SARS-CoV-2 阳性结果确定。
所有 HD 患者均在发热（≥37.4°C）或 PCR 阳性结果出现后 16 小时内开始使用 RDV，连续 5 或 10 天，每天 100mg 静脉内给药 1 次。
所有患者在 2 周内完全康复，未发生严重 COVID-19。2 名患者出现轻度肝功能障碍，但为一过性，即使继续 RDV 治疗也可自行缓解。在任何患者中，均无需因不良事件而停止 RDV 治疗。
本病例表明，早期使用 RDV 干预可能有助于获得良好的结果，并且即使在 HD 患者中，连续 10 天每天给予 RDV 也可耐受。文献复习未发现以前有文章报道过如此早期和更长时间使用 RDV 的疗效和安全性，因此本报告为临床医生考虑在 HD 患者中使用 RDV 提供了信息。
