Early experience with remdesivir in SARS-CoV-2 pneumonia

Emanuele Durante-Mangoni; Roberto Andini; Lorenzo Bertolino; Ferruccio Mele; Letizia Lucia Florio; Patrizia Murino; Antonio Corcione; Rosa Zampino

doi:10.1007/s15010-020-01448-x

Early experience with remdesivir in SARS-CoV-2 pneumonia

Infection. 2020 Oct;48(5):779-782. doi: 10.1007/s15010-020-01448-x. Epub 2020 May 16.

Authors

Emanuele Durante-Mangoni^{1

2}, Roberto Andini³, Lorenzo Bertolino⁴, Ferruccio Mele⁴, Letizia Lucia Florio⁴, Patrizia Murino⁵, Antonio Corcione⁵, Rosa Zampino^{4

3}

Affiliations

¹ Division of Internal Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Piazzale Ettore Ruggieri, 80131, Naples, Italy. [email protected].
² Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy. [email protected].
³ Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy.
⁴ Division of Internal Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Piazzale Ettore Ruggieri, 80131, Naples, Italy.
⁵ Intensive Care Unit, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy.

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: Antiviral therapy; COVID 19; Pneumonia; Remdesivir; SARS-CoV-2.

Publication types

Case Reports

MeSH terms

Adenosine Monophosphate / administration & dosage
Adenosine Monophosphate / adverse effects
Adenosine Monophosphate / analogs & derivatives*
Alanine / administration & dosage
Alanine / adverse effects
Alanine / analogs & derivatives*
Antiviral Agents / administration & dosage*
Antiviral Agents / adverse effects
Betacoronavirus / drug effects*
Betacoronavirus / immunology
COVID-19
Chemical and Drug Induced Liver Injury / diagnosis
Chemical and Drug Induced Liver Injury / etiology
Chemical and Drug Induced Liver Injury / physiopathology
Chemical and Drug Induced Liver Injury / virology
Convalescence
Coronavirus Infections / drug therapy*
Coronavirus Infections / virology
Critical Illness
Darunavir / administration & dosage
Darunavir / adverse effects
Drug Administration Schedule
Drug Combinations
Fatal Outcome
Humans
Hydroxychloroquine / administration & dosage
Hydroxychloroquine / adverse effects
Lopinavir / administration & dosage
Lopinavir / adverse effects
Multiple Organ Failure / chemically induced
Multiple Organ Failure / diagnosis
Multiple Organ Failure / physiopathology
Multiple Organ Failure / virology
Pandemics
Pneumonia, Viral / drug therapy*
Pneumonia, Viral / virology
RNA, Viral / blood*
Ritonavir / administration & dosage
Ritonavir / adverse effects
SARS-CoV-2
Torsades de Pointes / chemically induced
Torsades de Pointes / diagnosis
Torsades de Pointes / physiopathology
Torsades de Pointes / virology

Substances

Antiviral Agents
Drug Combinations
RNA, Viral
lopinavir-ritonavir drug combination
Lopinavir
remdesivir
Adenosine Monophosphate
Hydroxychloroquine
Ritonavir
Alanine
Darunavir