Experience of Treating COVID-19 With Remdesivir and Convalescent Plasma in a Resource-Limited Setting: A Prospective, Observational Study.
COVID-19
convalescent plasma
remdesivir
Journal
Open forum infectious diseases
ISSN: 2328-8957
Titre abrégé: Open Forum Infect Dis
Pays: United States
ID NLM: 101637045
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
received:
08
07
2021
accepted:
20
07
2021
entrez:
25
8
2021
pubmed:
26
8
2021
medline:
26
8
2021
Statut:
epublish
Résumé
Convalescent plasma therapy (CPT) and remdesivir (REM) have been approved for investigational use to treat coronavirus disease 2019 (COVID-19) in Nepal. In this prospective, multicentered study, we evaluated the safety and outcomes of treatment with CPT and/or REM in 1315 hospitalized COVID-19 patients over 18 years in 31 hospitals across Nepal. REM was administered to patients with moderate, severe, or life-threatening infection. CPT was administered to patients with severe to life-threatening infections who were at high risk for progression or clinical worsening despite REM. Clinical findings and outcomes were recorded until discharge or death. Patients were classified as having moderate (24.2%), severe (64%), or life-threatening (11.7%) COVID-19 infection. The majority of CPT and CPT + REM recipients had severe to life-threatening infections (CPT 98.3%; CPT + REM 92.1%) and were admitted to the intensive care unit (ICU; CPT 91.8%; CPT + REM 94.6%) compared with those who received REM alone (73.3% and 57.5%, respectively). Of 1083 patients with reported outcomes, 78.4% were discharged and 21.6% died. The discharge rate was 84% for REM (n = 910), 39% for CPT (n = 59), and 54.4% for CPT + REM (n = 114) recipients. In a logistic model comparing death vs discharge and adjusted for age, gender, steroid use, and severity, the predicted margin for discharge was higher for recipients of remdesivir alone (0.82; 95% CI, 0.79-0.84) compared with CPT (0.58; 95% CI, 0.47-0.70) and CPT + REM (0.67; 95% CI, 0.60-0.74) recipients. Adverse events of remdesivir and CPT were reported in <5% of patients. This study demonstrates a safe rollout of CPT and REM in a resource-limited setting. Remdesivir recipients had less severe infection and better outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Convalescent plasma therapy (CPT) and remdesivir (REM) have been approved for investigational use to treat coronavirus disease 2019 (COVID-19) in Nepal.
METHODS
METHODS
In this prospective, multicentered study, we evaluated the safety and outcomes of treatment with CPT and/or REM in 1315 hospitalized COVID-19 patients over 18 years in 31 hospitals across Nepal. REM was administered to patients with moderate, severe, or life-threatening infection. CPT was administered to patients with severe to life-threatening infections who were at high risk for progression or clinical worsening despite REM. Clinical findings and outcomes were recorded until discharge or death.
RESULTS
RESULTS
Patients were classified as having moderate (24.2%), severe (64%), or life-threatening (11.7%) COVID-19 infection. The majority of CPT and CPT + REM recipients had severe to life-threatening infections (CPT 98.3%; CPT + REM 92.1%) and were admitted to the intensive care unit (ICU; CPT 91.8%; CPT + REM 94.6%) compared with those who received REM alone (73.3% and 57.5%, respectively). Of 1083 patients with reported outcomes, 78.4% were discharged and 21.6% died. The discharge rate was 84% for REM (n = 910), 39% for CPT (n = 59), and 54.4% for CPT + REM (n = 114) recipients. In a logistic model comparing death vs discharge and adjusted for age, gender, steroid use, and severity, the predicted margin for discharge was higher for recipients of remdesivir alone (0.82; 95% CI, 0.79-0.84) compared with CPT (0.58; 95% CI, 0.47-0.70) and CPT + REM (0.67; 95% CI, 0.60-0.74) recipients. Adverse events of remdesivir and CPT were reported in <5% of patients.
CONCLUSIONS
CONCLUSIONS
This study demonstrates a safe rollout of CPT and REM in a resource-limited setting. Remdesivir recipients had less severe infection and better outcomes.
Identifiants
pubmed: 34430672
doi: 10.1093/ofid/ofab391
pii: ofab391
pmc: PMC8379705
doi:
Banques de données
ClinicalTrials.gov
['NCT04570982']
Types de publication
Journal Article
Langues
eng
Pagination
ofab391Investigateurs
Roshan Kumar Jha
(RK)
Anil Shrestha
(A)
Ashesh Dhungana
(A)
Shreejana Shrestha
(S)
Sarita Pandey
(S)
Sangita Shakya
(S)
Philip S Ranjit
(PS)
Sunil Dhungel
(S)
Devendra Bhattarai
(D)
Sumitra Gautam
(S)
Pramod Poudel
(P)
Kalyan Sapkota
(K)
Khagendra J Shah
(KJ)
Rajesh K Mandal
(RK)
Rajan Pandey
(R)
Sumit Prajapati
(S)
Arif Hussain
(A)
Shakuntala Gupta
(S)
Roshan Chhetri
(R)
Krishna Pokharel
(K)
Kala Thapa
(K)
Shital Adhikari
(S)
Gopendra P Deo
(GP)
Basanta Gauli
(B)
Pukar Ghimire
(P)
Bishnu Regmi
(B)
Ram B Gurung
(RB)
Rajeev Shrestha
(R)
Dipesh Tamrakar
(D)
Sushil Khanal
(S)
Upasana Acharya
(U)
Suhail Sapkota
(S)
Reema Shrestha
(R)
Milesh J Sijapati
(MJ)
Smriti Koirala
(S)
Suraj Bajracharya
(S)
Deepak Sigdel
(D)
Den P Acharya
(DP)
Sudarshan Chhetri
(S)
Prashanta Acharya
(P)
Hari P Panthi
(HP)
Ashesh Dhungana
(A)
Achyut R Karki
(AR)
Ram K Singh
(RK)
Uday N Singh
(UN)
Rakesh Tiwari
(R)
Asraf Hussain
(A)
Rupesh Shah
(R)
Parwez A Ansari
(PA)
Diptesh Aryal
(D)
Sanjit K Shrestha
(SK)
Kanchan Koirala
(K)
Kiran Kumar Kc
(K)
Bidur P Acharya
(BP)
Shyam Bk
(S)
Sumit Pandey
(S)
Suraj K Gupta
(SK)
Deepa Shakya
(D)
Yunima Sapkota
(Y)
Anju Adhikari
(A)
Bishwanath Koirala
(B)
Bipin Karki
(B)
Yuba R Sharma
(YR)
Bimal K Pandey
(BK)
Buddhi S Lamichhane
(BS)
Sanjay Shrestha
(S)
Sher B Kamar
(SB)
Ashok Chaudhary
(A)
Jagdish Joshi
(J)
Kunjang Sherpa
(K)
Reeju Manandhar
(R)
Chiranjibi Pant
(C)
Rinku Joshi
(R)
Anup Bastola
(A)
Bimal S Chalise
(BS)
Santa K Das
(SK)
Pramesh S Shrestha
(PS)
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
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