Original Article

Early outpatient administration of Remdesivir shortens recovery time in patients with mild to moderate COVID-19

Abstract

Background

During COVID-19, healthcare systems in underdeveloped nations had significant challenges and were unlikely to offer the necessary care. It appears that a new, reliable healthcare model that prevents hospitalization is necessary to reduce the pressure that COVID-19 is putting on healthcare systems and patients. More particularly, as Remdesivir's use as an outpatient treatment for mild to severe SARS-CoV-2 infection has rarely been examined; we aimed to investigate in-depth comprehension of the effects of Remdesivir in these cases.

Methods

In our two-month cross-sectional study, non-hospitalized patients with mild to moderate COVID-19 who were referred to the hospital for up to 5 days of Remdesivir treatment received 200 mg of Remdesivir intravenously on day 1, followed by 100 mg of Remdesivir once daily for the subsequent 4 days. Patients were divided into groups based on the time of starting Remdesivir treatment after the appearance of symptoms: group 1 less than and equal to 7 days, and group 2 more than 7 days. Two groups were evaluated for a correlation between Remdesivir administration time and clinical symptoms on days 1 and 14 (follow-up visits).

Results

The study enrolled 273 eligible patients with a mean age of 47.5 years, of whom 112 were males and 125 were females. Results showed that patients who received Remdesivir in the first 7 days had less dyspnea (P-value<0.0001) and lung involvement (P-value<0.0001) than those who received it after 7 days at the end of the study. Patients who came later to receive Remdesivir also showed higher fatigue, AST, and ALT levels on the first day.

Conclusions

Among patients with moderate COVID-19, those who received a 5-day course of Remdesivir within 7 days of the onset of symptoms had a statistically significant difference in clinical status compared with those who received their treatments later. However, the size of this finding has uncertain clinical importance.

1. Emanuel EJ, Persad G, Upshur R, et al. Fair allocation of scarce medical resources in the time of Covid-19. Mass Medical Soc. 2020.;2049-55.
2. Sun T, Wan W, Wu Z, Zhang J, Zhang L. Clinical outcomes and natural history of pediatric brainstem tumors: with 33 cases follow-ups. Neurosurg Rev. 2013;36:311-20.
3. Turner HC, Van Hao N, Yacoub S, et al. Achieving affordable critical care in low-income and middle-income countries. BMJ Global Health. 2019;4(3):e001675.
4. Bao Y, Sun Y, Meng S, Shi J, Lu L. 2019-nCoV epidemic: address mental health care to empower society. Lancet. 2020;395(10224):e37-e8.
5. 2020 Year in Review: The impact of COVID-19 in 12 charts [Internet]. 2020.
6. Kim PS, Read SW, Fauci AS. Therapy for Early COVID-19: A Critical Need. JAMA. 2020;324(21):2149-50.
7. Grundeis F, Ansems K, Dahms K, Thieme V, et al. Remdesivir for the treatment of COVID-19. Cochrane Database Syst Rev. 2023;1(1):CD014962.
8. Risch HA. Early outpatient treatment of symptomatic, high-risk Covid-19 patients that should be ramped-up immediately as key to the pandemic crisis. Am J Epidemiol. 2020 Nov 2;189(11):1218-1226.
9. Ghaffari Darab M, Keshavarz K, Sadeghi E, Shahmohamadi J, Kavosi Z. The economic burden of coronavirus disease 2019 (COVID-19): evidence from Iran. BMC Health Serv Res. 2021;21(1):1-7.
10. Pan DZ, Odorizzi PM, Schoenichen A, et al. Remdesivir improves biomarkers associated with disease severity in COVID-19 patients treated in an outpatient setting. Commun Med (Lond). 2023;3(1):2.
11. Gottlieb RL, Vaca CE, Paredes R, et al. Early remdesivir to prevent progression to severe Covid-19 in outpatients. N Engl J Med. 2022;386(4):305-15.
12. Piccicacco N, Zeitler K, Ing A, et al. Real-world effectiveness of early remdesivir and sotrovimab in the highest-risk COVID-19 outpatients during the Omicron surge. J Antimicrob Chemother. 2022;77(10):2693-700.
13. Tiseo G, Barbieri C, Galfo V, et al. Efficacy and safety of nirmatrelvir/ritonavir, molnupiravir, and remdesivir in a real-world cohort of outpatients with COVID-19 at high risk of progression: the PISA Outpatient Clinic Experience. Infect Dis Ther. 2023;12(1):257-71.
14. Rajme-López S, Martinez-Guerra BA, Zalapa-Soto J, et al. Early Outpatient Treatment With Remdesivir in Patients at High Risk for Severe COVID-19: A Prospective Cohort Study. Open Forum Infect Dis. 2022;9(10):ofac502.
15. Rezagholizadeh A, Khiali S, Sarbakhsh P, Entezari-Maleki T. Remdesivir for treatment of COVID-19; an updated systematic review and meta-analysis. Eur J Pharmacol. 2021;897:173926.
Files
IssueVol 11, No 4 (Autumn 2023) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jpc.v11i4.16017
Keywords
COVID-19; SARS-CoV-2; Outpatient; Remdesivir; Complications

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Hajimaghsoudi M, Saghafi F, Shorabi M, Mirzaei S, Moharami M, Daryaei N, Hoseinzade F, Jalili F, Rezaei HR, Rameshi Y, Gholinataj Jelodar M. Early outpatient administration of Remdesivir shortens recovery time in patients with mild to moderate COVID-19. J Pharm Care. 2023;11(4):207-213.