Role of Remdesivir in Covid-19 Patients: A Study from the Capital City of Pakistan

Main Article Content

Dr Aziz-un-nisa Dr. Dur Muhammad Dr. Khizra Maqbool

Abstract

Background Coronavirus disease 2019, caused by SARS-COVID-19 has emerged as a pandemic. It usually causes severe respiratory disease. Characteristically it undergoes genetic variability and newer strains emerge as a result of genetic mutations or environmental factors. It makes it difficult to be treated. We used remdesivir in our hospital to treat covid-19 patients. The aim of our study was to evaluate the role of remdesivir in COVID-19 patients.


Patients and Methods We conducted a descriptive cross sectional study on the patients admitted in the department of Medicine, Capital hospital, Islamabad, Pakistan from November 2020 to October 2021. All patients aged 14 years and above were included. Both SARS-CoV-2 positive patients by molecular biology and COVID suspected cases, selected on the basis of low oxygen saturation, deranged inflammatory markers, positive contact history and radiological findings with negative COVID19 PCR testing were included in the study. The data was compiled using Microsoft Excel and later was analyzed on SPSS version 24.


Results Among 669 patients, 375 (56.1 %) were males and 294 (43.9%) were females. Median age of patients was 58.2 years. 349 (52.2%) were COVID PCR positive and 320 (47.8%) were PCR negative. Out of 669 patients 573 (85.7%) were discharged and 96 (14.3%) expired. Inflammatory markers before and after the treatment were measured with overall significant decrease (P-value 0.000) after treatment. Patients were divided into two groups, remdesivir given (n=436) and remdesivir not given (n=233). Hospital stay was of shorter duration among 249(57.6%) in remdesivir given group than in remdesivir not given group 183(42.4%). While evaluating outcome 370(64.6%) patients were discharged and 66(68.7%) expired in remdesivir given group and 203 (35.4%) patients were discharged and 30 (31.3%) expired in second group. Lactic dehydrogenase (LDH) level was raised (>480 U/L) in 378(68.5%) patients before taking remdesivir and was raised only in 209(47.9%) patients after taking remdesivir (P-0.027).


Conclusion Our study revealed that Hospital stay was shorter (P-value 0.000) in remdesivir given group. There was no significant effect of remdesivir on patient’s outcome and mortality (P-value 0.250). Only Lactic dehydrogenase was significantly decreased (p-value 0.027) in remdesivir given group.


Key words COVID-19, Remdesivir, outcome, Inflammatory markers

Keywords: COVID-19, Remdesivir, outcome, Inflammatory markers

Article Details

How to Cite
AZIZ-UN-NISA, Dr; MUHAMMAD, Dr. Dur; MAQBOOL, Dr. Khizra. Role of Remdesivir in Covid-19 Patients: A Study from the Capital City of Pakistan. Medical Research Archives, [S.l.], v. 10, n. 4, apr. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2769>. Date accessed: 29 mar. 2024. doi: https://doi.org/10.18103/mra.v10i4.2769.
Section
Research Articles

References

1. Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol 5, 536–544 (2020). https://doi.org/10.1038/s41564-020-0695-z
2. Ksiazek, T. G. (2003). A novel coronavirus associated with severe acute respiratory syndrome. New England journal of medicine, 348(20).
3. WHO. (2021, December 28). Weekly epidemiological update on COVID-19. Retrieved from World Health Organization: https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---28-december-2021
4. Government of Pakistan. (2021, December). Pakistan Cases Details. Retrieved from covid.gov.pk: https://covid.gov.pk/stats/pakistan
5. Belmehdi, O. H. (2021). Molecular structure, pathophysiology, and diagnosis of COVID-19. Biointerface Research in Applied Chemistry, 11(3);10215-10237,2021.
6. Hu, B. H. (2021). The cytokine storm and COVID‐19). J Med Virol. 2020 Jun 27: 10.1002/jmv.26232. doi: 10.1002/jmv.26232.
7. Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus Disease 2019 Case Surveillance-United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:759-765.
8. WHO. (2022, February 22). Tracking SARS-CoV-2 variants. Retrieved from World Health Organization: https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/
9. Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the treatment of COVID-19-final report. N Engl J Med. 2020;383(19):1813-1826.
10. WHO (2022, January 14). WHO recommends two new drugs to treat COVID-19. Retrieved from https://www.who.int/news/item/14-01-2022-who-recommends-two-new-drugs-to-treat-covid-19
11. Alkhouli M, Nanjundappa A, Annie F, Bates MC, Bhatt DL. Sex Differences in Case Fatality Rate of COVID-19: Insights From a Multinational Registry. Mayo Clin Proc. 2020;95(8):1613-1620. doi:10.1016/j.mayocp.2020.05.014
12. Haitao T, Vermunt, JV. et al. COVID-19 and sex differences: mechanisms and biomarkers. Mayo Clin Proc. 2020 Oct;95(10):2189-2203.
13. Hampton T. Insight on Sex-Based Immunity Differences, With COVID-19 Implications. JAMA. 2020 Oct 6;324(13):1274. doi: 10.1001/jama.2020.17378. PMID: 33021653.
14. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5
15. Shoaib N, Noureen N, Munir R, et al. (2021) COVID-19 severity: Studying the clinical and demographic risk factors for adverse outcomes. PLoS ONE 16(8):e0255999. https://doi.org/10.1371/journal.
16. Akhtar H, Khalid S, Rahman Fu, et al. Presenting Characteristics, Comorbidities, and Outcomes Among Patients With COVID-19 Hospitalized in Pakistan: Retrospective Observational Study. JMIR Public Health Surveill 2021;7(12):e32203 doi: 10.2196/32203.
17. Gessler N, Gunawardene MA, et al. (2021) Clinical outcome, risk assessment, and seasonal variation in hospitalized COVID-19 patients—Results from the CORONA Germany study. PLoS ONE 16(6): e0252867. https://doi.org/10.1371/journal.pone.0252867

18. Cui Z, Merritt Z, Assa A,et al. Early and Significant Reduction in C-Reactive Protein Levels After Corticosteroid Therapy Is Associated With Reduced Mortality in Patients With COVID-19. J Hosp Med. 2021 Mar;16(3):142-148. doi: 10.12788/jhm.3560. PMID: 33617431.
19. Wu et al. Clinical evaluation of potential usefulness of serum lactate dehydrogenase (LDH) in 2019 novel coronavirus (COVID-19) pneumonia. Respiratory Research (2020) 21:171. https://doi.org/10.1186/s12931-020-01427-8
20. Aiswarya D, Arumugam V, et al. Use of Remdesivir in Patients With COVID-19 on Hemodialysis: A Study of Safety and Tolerance. Kidney Int Rep. 2021 Mar;6(3):586-593. doi:10.1016/j.ekir.2020.12.003.
21. Gebhard, C, Regitz-Zagrosek, V, Neuhauser, H.K. et al. Impact of sex and gender on COVID-19 outcomes in Europe. Biol Sex Differ 11, 29 (2020). https://doi.org/10.1186/s13293-020-00304-9
22. Gottlieb RL, Vaca CE, Paredes R, et al. Early Remdesevir to Prevent Progression to Severe Covid-19 in Outpatients. N Engl J Med 2022; 386(4):305-315.
23. Gupte V, Hegde R, Sawant, S. et al. Safety and clinical outcomes of remdesevir in hospitalized COVID-19 patients: a retrospective analysis of active surveillance database. BMC Infect Dis 22, 1(2022).
24. Dyer O. Covid-19: Remdesivir has little or no impact on survival, WHO trial shows BMJ 2020:371:m4057.
25. Santenna C, Vidyasagar K, Amarneni KC, Ghanta SN, Sadasivam B, Pathan S, Padmavathi R. The safety, tolerability and mortality reduction efficacy of remdesivir; based on randomized clinical trials, observational and case studies reported safety outcomes: an updated systematic review and meta-analysis. Ther Adv Drug Saf. 2021 Sep 24;12:20420986211042517. doi: 10.1177/20420986211042517.
26. John H. Beigel, Kay M. Tomashek, Remdesivir for the Treatment of Covid-19 — Final Report. N Engl J Med 2020; 383:1813-1826 DOI: 10.1056/NEJMoa2007764
27. Barratt-Due A, Olsen IC, Nezvalova-Henriksen K, et. al. NOR-Solidarity trial. Evaluation of the Effects of Remdesivir and Hydroxychloroquine on Viral Clearance in COVID-19 : A Randomized Trial. Ann Intern Med. 2021 Sep;174(9):1261-1269. doi: 10.7326/M21-0653.