Is There Enough Evidence to Avoid Remdesivir Use in Patients with Severe Renal Impairment? A Review of the Pharmacological and Clinical Literature

Abstract

Although patients with severe renal impairment (SRI) typically experience more critical symptoms once infected with novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus-2, this population has often been excluded from randomized controlled trials (RCT) for Coronavirus disease-2019 (COVID-19) treatment strategies. Of particular note, all RCTs for remdesivir (Veklury®), the only antiviral treatment approved by the Food and Drug Administration for COVID-19 intervention, excluded patients with an estimated glomerular filtration rate less than 30 ml/min. Regardless, some physicians have ventured to utilize this drug on patients with SRI, positing that the benefits might outweigh the risks of its use. The intent of this literature review was to examine the pharmacology of remdesivir and evaluate the published clinical literature on the topic to determine more definitively whether it might be safe to use in this population. A total of 59 articles were evaluated, seven of which contained descriptions of SRI patients treated with remdesivir for COVID-19, for a total of 176 patients. Interestingly, none of the patients experienced severe adverse reactions attributable to the use of remdesivir, and none of the investigators recommended against its use. While there is not yet clear evidence to suggest improvement in mortality, decreased morbidity and duration of illness are likely to lower mortality rates among these patients. Therefore, these findings suggest that, for patients with SRI diagnosed with COVID-19, the benefits of using remdesivir likely outweigh the risks. RCTs are urgently needed to further elucidate outcomes among this population.

Keywords

• remdesivir
• covid-19
• severe renal impairment
• end stage renal disease
• therapeutics