Early experience with remdesivir in SARS-CoV-2 pneumonia
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CASE REPORT
Early experience with remdesivir in SARS‑CoV‑2 pneumonia Emanuele Durante‑Mangoni1,2 · Roberto Andini2 · Lorenzo Bertolino1 · Ferruccio Mele1 · Letizia Lucia Florio1 · Patrizia Murino3 · Antonio Corcione3 · Rosa Zampino1,2 Received: 4 April 2020 / Accepted: 12 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract At present, there is no definitive antiviral treatment for coronavirus disease 2019 (COVID-19). We describe our early experience with remdesivir in four critically ill COVID-19 patients. Patients received a 200 mg loading dose, followed by 100 mg daily intravenously for up to 10 days. All patients had been previously treated with other antivirals before remdesivir initiation. One patient experienced a torsade de pointes requiring cardiac resuscitation and one died due to multiple organ failure. Three patients showed biochemical signs of liver injury. Lymphocyte count increased in all patients soon after remdesivir initiation. Nasal swab SARS-CoV-2 RNA became negative in three of four patients after 3 days of therapy. We observed an in vivo virological effect of remdesivir in four critically ill, COVID-19 patients, coupled with a significant burden of adverse events. Although limited by the low number of subjects studied, our preliminary experience may be relevant for clinicians treating COVID-19. Keywords Remdesivir · SARS-CoV-2 · COVID 19 · Pneumonia · Antiviral therapy The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in China in December 2019, causing severe pneumonia and acute respiratory distress syndrome [1]. Over the following few months, infection spread worldwide and WHO declared the status of a pandemic in March 11, 2020. Currently, no definitive antiviral treatment for coronavirus disease 2019 (COVID-19) has been identified. Lopinavir/ritonavir (LPV/r) combination was not effective in adult patients with severe COVID-19 [2]. Hydroxychloroquine (HCQ) exhibits a consistent inhibitory activity on SARSCoV-2 in vitro [3] and has shown promising results in a small cohort of patients with different severity of disease [4]. Remdesivir (RDV), a newer nucleotide analogue RNA polymerase inhibitor, originally developed for Ebola virus * Emanuele Durante‑Mangoni [email protected] 1
Division of Internal Medicine, University of Campania ‘L. Vanvitelli’, Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy
2
Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
3
Intensive Care Unit, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
disease, shows in vitro efficacy against coronaviruses, including SARS-CoV-2 [5]. Recent clinical data on the efficacy and safety of RDV for COVID-19 have been published [6]. Thus, while clinical trials are ongoing, additional experience can be derived from initial COVID-19 cases treated with RDV. We describe our early clinical experience with the use of RDV in four COVID-19 patients admitted to the Monaldi Hospital, Naples, It
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