What is the COVID-19 protocol for Remdesivir (remdesivir) treatment?

From the Guidelines

Remdesivir should be administered for COVID-19 in hospitalized patients who require supplemental oxygen but are not on mechanical ventilation, with a standard dosing protocol of 200 mg intravenously on day 1, followed by 100 mg IV daily for 4 additional days (5 days total), and extended to up to 10 days total if patients are not improving after 5 days. This recommendation is based on the most recent and highest quality study available, which suggests that a 5-day course of remdesivir may be as effective as a 10-day course, with no increase in potential harms 1. The medication should be administered by healthcare professionals in a hospital setting with appropriate monitoring for potential side effects, particularly liver and kidney function tests before and during treatment. Some key points to consider when administering remdesivir include:

• The medication is contraindicated in patients with severe kidney impairment (eGFR <30 mL/min) and should be used cautiously in those with liver dysfunction 1.
• Treatment is most effective when started early in the disease course, ideally within 10 days of symptom onset, and is generally reserved for patients at high risk of disease progression 1.
• Common side effects include nausea, headache, and elevated liver enzymes, and the medication works as an antiviral by inhibiting viral RNA-dependent RNA polymerase, preventing viral replication 1. It is essential to note that the decision to initiate treatment with remdesivir should be based on clinical judgment, taking into account the balance of benefits and harms, and considering the individual patient's condition and disease severity 1.

From the FDA Drug Label

Remdesivir was not efficiently removed through hemodialysis. Average hemodialysis clearance of GS-441524 and GS-704277 was 149 mL/minute and 92. 6 mL/minute, respectively Table 17 Comparison of PK Parameters* of Remdesivir and Metabolites (GS-441524 and GS-704277) Following IV Administration of Single Dose VEKLURY to Adults with Renal Impairment† as Compared to Adults with Normal Renal Function Table 18 Comparison of PK Parameters of Remdesivir and Metabolites (GS-441524 and GS-704277) Following IV Administration of VEKLURY (200 mg on Day 1 Followed by 100 mg Daily on Days 2–5) in Adults with COVID-19 with* or without† Severely Reduced Kidney Function‡

The COVID-19 protocol for Remdesivir (remdesivir) treatment is a 200 mg loading dose on Day 1 followed by 100 mg from Day 2 to Day 5.

• The dosing regimen is for patients with severely reduced kidney function, including those with acute kidney injury (AKI), chronic kidney disease (CKD), or end-stage renal disease (ESRD) requiring hemodialysis.
• The pharmacokinetics of remdesivir were not affected by renal function or timing of administration around dialysis 2.

From the Research

COVID-19 Protocol for Remdesivir Treatment

The COVID-19 protocol for Remdesivir treatment involves the administration of Remdesivir as an antiviral therapy for moderate to severe COVID-19 cases. The following points outline the key aspects of the protocol:

• Remdesivir is the mainstay antiviral therapy for moderate to severe COVID-19, with benefits including lessening the duration of hospitalization, alleviating respiratory complications, and reducing mortality 3.
• The dose regimen of Remdesivir is an IV loading dose of 200 mg on day 1, followed by daily IV maintenance doses of 100 mg for 5-9 days 4.
• Remdesivir has shown significant benefits for outpatients with mild to moderate disease, including reduced COVID-19-related hospitalization, all-cause hospitalization, and need for medically-attended visits 5.
• For hospitalized patients, Remdesivir has a slight benefit in reducing all-cause mortality at day 28, and subgroup analysis shows a trend towards reduction in mortality among those with severe disease 5.
• Remdesivir has been shown to decrease clinical deterioration, improve recovery rate, and reduce the need for mechanical ventilation, with no increased risk of adverse events 5, 6.
• The use of Remdesivir depends on disease severity, with benefits seen in patients with mild, moderate, and severe COVID-19 infection, but not in those with critical disease requiring mechanical ventilation 5, 7.

Key Considerations

Some key considerations for the use of Remdesivir in COVID-19 treatment include:

• Remdesivir is an intravenously administered antiviral drug that inhibits RNA-dependent RNA polymerase 5.
• The safety profile of Remdesivir is generally good, with most adverse effects being moderate to mild, including liver and kidney impairment 3, 7.
• Remdesivir may be beneficial in combination with other treatments, such as corticosteroids and monoclonal antibody combinations, for certain patient populations 6.
• Future studies should provide additional data on the efficacy and safety of Remdesivir for defined core outcomes in COVID-19 research, especially for different population subgroups 7.