Compassionate Use of Remdesivir for Patients with Severe Covid 19
Abstract Background Remdesivir, a nucleotide analogue prodrug that inhibits viral RNA polymerases, has shown in vitro activity against SARS CoV 2. Methods We provided remdesivir on a compassionate use basis to patients hospitalized with Covid 19, the illness caused by infection with SARS CoV 2. Patients were those with confirmed SARS CoV 2 infection who had an oxygen saturation of 94% or less while they were breathing ambient air or who were receiving oxygen support. Patients received a 10 day course of remdesivir, consisting of 200 mg administered intravenously on day 1, followed by 100 mg daily for the remaining 9 days of treatment. This report is based on data from patients who received remdesivir during the period from January 25, 2020, through March 7, 2020, and have clinical data for at least 1 subsequent day. Results Of the 61 patients who received at least one dose of remdesivir, data from 8 could not be analyzed (including 7 patients with no post treatment data and 1 with a dosing error) Of the 53 patients whose data were analyzed, 22 were in the United States, 22 in Europe or Canada, and 9 in Japan. At baseline, 30 patients (57% were receiving mechanical ventilation and 4 (8% were receiving extracorporeal membrane oxygenation. During a median follow up of 18 days, 36 patients (68% had an improvement in oxygen support class, including 17 of 30 patients (57% receiving mechanical ventilation who were extubated. A total of 25 patients (47% were discharged, and 7 patients (13% died; mortality was 18% (6 of 34) among patients receiving invasive ventilation and 5% (1 of 19) among those not receiving invasive ventilation. Conclusions In this cohort of patients hospitalized for severe Covid 19 who were treated with compassionate use remdesivir, clinical improvement was observed in 36 of 53 patients (68% Measurement of efficacy will require ongoing randomized, placebo controlled trials of remdesivir therapy. (Funded by Gilead Sciences.
The New England journal of medicine