Efficacy and safety of early administration of remdesivir in hemodialysis patients with COVID-19: A case report and literature review.

RATIONALE

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.

PATIENT CONCERNS

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).

DIAGNOSES

The diagnosis of COVID-19 was confirmed by the real-time polymerase chain reaction (PCR) for SARS-CoV-2.

INTERVENTIONS

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.

OUTCOMES

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.

LESSONS

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.