J Korean Med Sci.  2021 Mar;36(11):e83. 10.3346/jkms.2021.36.e83.

Clinical and Virologic Effectiveness of Remdesivir Treatment for Severe Coronavirus Disease 2019 (COVID-19) in Korea: a Nationwide Multicenter Retrospective Cohort Study

Affiliations
  • 1Division of Infectious Diseases, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 2Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 3Division of Infectious Diseases, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
  • 4Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
  • 5Division of Pulmonary and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
  • 6Division of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
  • 7Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
  • 8Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 9Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Korea
  • 10Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
  • 11Department of Infectious Diseases, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
  • 12Division of Infectious Disease, Department of Medicine, Seongnam Citizens Medical Center, Seongnam, Korea
  • 13Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, ChungAng University College of Medicine, Seoul, Korea
  • 14Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
  • 15Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
  • 16Department of Infectious Diseases, National Health Insurance Service Ilsan Hospital, Goyang, Korea
  • 17Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
  • 18Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
  • 19Division of Infectious Disease, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 20Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea

Abstract

Background
Remdesivir is widely used for the treatment of coronavirus disease 2019 (COVID-19), but controversies regarding its efficacy still remain.
Methods
A retrospective cohort study was conducted to evaluate the effect of remdesivir on clinical and virologic outcomes of severe COVID-19 patients from June to July 2020. Primary clinical endpoints included clinical recovery, additional mechanical ventilator (MV) support, and duration of oxygen or MV support. Viral load reduction by hospital day (HD) 15 was evaluated by calculating changes in cycle threshold (Ct) values.
Results
A total of 86 severe COVID-19 patients were evaluated including 48 remdesivirtreated patients. Baseline characteristics were not significantly different between the two groups. Remdesivir was administered an average of 7.42 days from symptom onset. The proportions of clinical recovery of the remdesivir and supportive care group at HD 14 (56.3% and 39.5%) and HD 28 (87.5% and 78.9%) were not statistically different. The proportion of patients requiring MV support by HD 28 was significantly lower in the remdesivir group than in the supportive care group (22.9% vs. 44.7%, P = 0.032), and MV duration was significantly shorter in the remdesivir group (average, 1.97 vs. 5.37 days; P = 0.017). Analysis of upper respiratory tract specimens demonstrated that increases of Ct value from HD 1–5 to 11–15 were significantly greater in the remdesivir group than the supportive care group (average, 10.19 vs. 5.36; P = 0.007), and the slope of the Ct value increase was also significantly steeper in the remdesivir group (average, 5.10 vs. 2.68; P = 0.007).
Conclusion
The remdesivir group showed clinical and virologic benefit in terms of MV requirement and viral load reduction, supporting remdesivir treatment for severe COVID-19.

Keyword

Remdesivir; Severe; COVID-19; Clinical; Virologic
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