What is the recommended inpatient management of COVID-19 using Remdesivir (RDV)?

From the Guidelines

Remdesivir (RDV) is recommended for hospitalized COVID-19 patients, with a standard regimen of a 200mg IV loading dose on day 1, followed by 100mg IV daily for 4 additional days (5 days total), which can be extended to 10 days if the patient's condition worsens and requires supplemental oxygen but not mechanical ventilation, as supported by the American College of Physicians 1. The decision to initiate treatment with remdesivir in hospitalized patients with COVID-19 should be based on clinical judgment, considering the balance of benefits and harms, and the medication should not be initiated in patients hospitalized for a primary diagnosis unrelated to COVID-19 who have incidentally tested positive for severe acute respiratory syndrome coronavirus 2 1. Some key considerations for the use of remdesivir include:

• Monitoring liver function before and during treatment, as remdesivir can cause elevated liver enzymes 1
• Contraindication in patients with severe renal impairment (eGFR <30 mL/min) and those with ALT levels ≥5 times the upper limit of normal 1
• Administration as an IV infusion over 30-120 minutes, with monitoring for infusion-related reactions 1
• Potential adverse events, including hyperglycemia, liver dysfunction, and renal failure, as reported in the ACTT trial 1 The effectiveness of a 10-d course of remdesivir in reducing mortality and time to recovery may not vary by age, sex, or race in hospitalized patients with COVID-19, as suggested by the evidence review 1. Overall, the use of remdesivir in hospitalized COVID-19 patients should be guided by clinical judgment, with careful consideration of the potential benefits and harms, and close monitoring for adverse events.

From the FDA Drug Label

The treatment course of VEKLURY should be initiated as soon as possible after diagnosis of symptomatic COVID-19 has been made. The recommended total treatment duration for hospitalized patients requiring invasive mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO) is 10 days The recommended treatment duration for hospitalized patients not requiring invasive mechanical ventilation and/or ECMO is 5 days.

The recommended inpatient management of COVID-19 using Remdesivir (RDV) involves initiating treatment as soon as possible after diagnosis. The treatment duration is 10 days for patients requiring invasive mechanical ventilation and/or ECMO, and 5 days for those not requiring these interventions. If a patient does not demonstrate clinical improvement, treatment may be extended for up to 5 additional days for a total treatment duration of up to 10 days 2.

From the Research

Inpatient Management of COVID-19 using Remdesivir (RDV)

Overview of Remdesivir Treatment

• Remdesivir is a broad-spectrum antiviral and was the first US Food and Drug Administration-approved treatment for COVID-19 3.
• It is currently the only recommended antiviral for use in hospitalized patients with COVID-19, with or without a supplemental oxygen requirement 3.
• Remdesivir has been shown to improve survival and disease progression in a variety of patient populations with COVID-19 across a spectrum of disease severity and SARS-CoV-2 variant periods 3.

Clinical Outcomes with Remdesivir Treatment

• Remdesivir treatment has been associated with improved clinical outcomes, including reduced time to clinical recovery, increased rate of recovery, and reduced time on supplemental oxygen and readmission rates 3, 4, 5.
• Early treatment with remdesivir has been shown to improve length of stay, reduce the need for mechanical ventilation, and decrease mortality in patients hospitalized with COVID-19 5.
• The combination of corticosteroid and remdesivir therapy has been shown to be non-inferior to corticosteroid monotherapy in reducing 28-day all-cause in-hospital mortality in critically ill COVID-19 patients, with a significant decrease in the incidence of secondary bacterial infections 6.

Recommendations for Inpatient Management

• Remdesivir is recommended for use in hospitalized patients with COVID-19, with or without a supplemental oxygen requirement 3.
• Early treatment with remdesivir is recommended, as it has been shown to improve clinical outcomes 5.
• The combination of corticosteroid and remdesivir therapy may be considered for critically ill COVID-19 patients, as it has been shown to be non-inferior to corticosteroid monotherapy in reducing 28-day all-cause in-hospital mortality 6.

Key Considerations

• Remdesivir should be initiated as soon as possible after hospital admission, as early treatment has been shown to improve clinical outcomes 5.
• The use of corticosteroids, remdesivir, and other treatments should be tailored to the individual patient's disease severity and medical history 7, 3.
• Pharmacists can play a role in ensuring appropriate access, correct administration, and safe use of COVID-19 treatments, including remdesivir 7.