From the Guidelines
Remdesivir is recommended for patients with severe COVID-19, with a 10-day course showing a net benefit compared to placebo, and should be administered intravenously with a dose of 200 mg on day 1 followed by 100 mg daily for the remaining days. The treatment protocol for Remdesivir (Veklury) in patients with COVID-19 involves administering the drug intravenously, generally in hospital settings, with two possible courses: a 5-day course for adults consisting of 200 mg IV on day 1 followed by 100 mg/d for a total of 5 days, and a 10-day course consisting of 200 mg IV on day 1 followed by 100 mg/d for a total of 10 days 1.
Key Considerations for Remdesivir Treatment
- The effectiveness of a 10-day course of remdesivir in reducing time to recovery in patients with severe COVID-19 may not vary by age, sex, or race 1.
- A greater percentage of patients with severe COVID-19 treated within 10 days of symptom onset versus after 10 days of symptom onset with a 5- or 10-day course of remdesivir were discharged from the hospital 1.
- The FDA recommends assessing kidney and hepatic function at baseline and during treatment, and not using remdesivir in patients with an eGFR <30 mL/min/1.73 m2 1.
- Common adverse events include hypersensitivity reactions, endocrine and metabolic events (such as hyperglycemia), hepatic events (including increased serum ALT and AST levels), and renal events (such as renal toxicity) 1.
Administration and Monitoring
- Remdesivir should be administered by healthcare professionals in a setting where severe hypersensitivity reactions can be managed if they occur.
- Baseline liver and kidney function tests should be performed before starting treatment, and monitoring should continue during treatment to assess for potential side effects such as elevation in liver enzymes.
- The cost of a 5-day course of remdesivir in the United States varies, and this should be considered in the context of patient care and access to treatment 1.
From the FDA Drug Label
The recommended dosage for adults and pediatric patients weighing at least 40 kg is a single loading dose of VEKLURY 200 mg on Day 1 via intravenous infusion followed by once-daily maintenance doses of VEKLURY 100 mg from Day 2 via intravenous infusion. The recommended dosage for pediatric patients weighing 1.5 kg to less than 40 kg is presented in Table 1. 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. 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 Non-hospitalized patients: The recommended total treatment duration for non-hospitalized patients diagnosed with mild-to-moderate COVID-19 who are at high risk for progression to severe COVID-19, including hospitalization or death, is 3 days.
The recommended treatment protocol for Remdesivir (Veklury) in patients with Covid-19 is as follows:
- Adults and pediatric patients weighing at least 40 kg:
- Loading dose: 200 mg on Day 1 via intravenous infusion
- Maintenance dose: 100 mg once daily from Day 2 via intravenous infusion
- Pediatric patients weighing 1.5 kg to less than 40 kg:
- Refer to Table 1 for dosage instructions
- Treatment duration:
- Hospitalized patients requiring invasive mechanical ventilation and/or ECMO: 10 days
- Hospitalized patients not requiring invasive mechanical ventilation and/or ECMO: 5 days
- Non-hospitalized patients with mild-to-moderate COVID-19 at high risk for progression: 3 days
- Extension of treatment: 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
Remdesivir Treatment Protocol for Covid-19
The recommended treatment protocol for Remdesivir (Veklury) in patients with Covid-19 is as follows:
- Remdesivir is approved for the treatment of coronavirus disease 2019 (COVID-19) and has been shown to reduce time to recovery and improve clinical outcomes in hospitalized patients with COVID-19 3.
- The treatment protocol typically involves daily intravenous infusions of remdesivir, with the duration of treatment depending on the severity of the disease and the patient's response to treatment 3, 4.
- Remdesivir has been shown to be effective in reducing mortality and improving clinical outcomes in patients with COVID-19 who require supplemental oxygen, particularly those with minimal oxygen requirements at baseline 3, 5, 4.
- The treatment protocol may vary depending on the patient's underlying health conditions, age, and other factors, and should be determined by a healthcare professional based on individual patient needs 6.
Patient Populations
Remdesivir has been shown to be effective in various patient populations, including:
- Hospitalized patients with moderate or severe COVID-19 3, 5, 4.
- Outpatients at high risk for progression to severe COVID-19 3, 6.
- Hospitalized pediatric patients with COVID-19 3.
- Patients with immunocompromising conditions 6.
Safety and Efficacy
Remdesivir has been generally well tolerated in clinical trials, but pharmacovigilance data have found an increased risk of hepatic, renal, and cardiovascular adverse drug reactions in the real-world setting 3. The efficacy of remdesivir in reducing mortality and improving clinical outcomes has been demonstrated in several studies, including the ACTT-1 trial and other randomized controlled trials 3, 5, 4, 6. In comparison to other treatments, such as baricitinib and dexamethasone, remdesivir has been shown to have a similar efficacy in reducing mechanical ventilation-free survival, but with a different safety profile 7.