Qualitative Subgenomic RNA to Monitor the Response to Remdesivir in Hospitalized Patients With Coronavirus Disease 2019: Impact on the Length of Hospital Stay and Mortality.

BACKGROUND

There is no reliable microbiological marker to guide the indication and the response to antiviral treatment in patients with coronavirus disease 2019 (COVID-19). We aimed to evaluate the dynamics of subgenomic RNA (sgRNA) in patients with COVID-19 before and after receiving treatment with remdesivir.

METHODS

We included consecutive patients admitted for COVID-19 who received remdesivir according to our institutional protocol and accepted to participate in the study. A nasopharyngeal swab for quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) was collected at baseline and after 3 and 5 days of treatment with remdesivir. Genomic and sgRNA were analyzed in those samples and main comorbidities and evolution were collected for the analyses. The main outcomes were early discharge (≤10 days) and 30-day mortality.

RESULTS

A total of 117 patients were included in the study, of whom 24 had a negative sgRNA at baseline, with 62.5% (15/24) receiving early discharge (≤10 days) and no deaths in this group. From the 93 remaining patients, 62 had a negative sgRNA at day 5 with 37/62 (59.6%) with early discharge and a mortality rate of 4.8% (3/62). In the subgroup of 31 patients with positive sgRNA after 5 days of remdesivir, the early discharge rate was 29% (9/31) and the mortality rate was 16.1% (5/31). In multivariable analyses, the variables associated with early discharge were negative sgRNA at day 3 and not needing treatment with corticosteroids or intensive care unit admission.

CONCLUSIONS

Qualitative sgRNA could help in monitoring the virological response in patients who receive remdesivir. Further studies are needed to confirm these findings.

Informations de copyright

© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: [e-mail].

Déclaration de conflit d'intérêts

Potential conflicts of interest. C. G.-V. has received support for attending meetings and/or travel and honoraria for talks on behalf of Gilead Sciences, Merck, Sharp and Dhome (MSD), Novartis, Pfizer, Janssen, and Lilly, as well as grants from Gilead Sciences and MSD. L. M. has received honoraria for talks on behalf of MSD; Pfizer; and Angelini. P. P.-A. has received honoraria for talks on behalf of Gilead Sciences and MSD. P. P.-A. also reports grants or contract from Rio Hortega (contract), Juan Rodes (contract), and a national competitive grant (to Instituto de Salud Carlos III); honoraria for lectures from Pfizer, Gilead S.A., ViiV Healthcare, and MSD; support for attending meetings and/or travel from Pfizer (National Congress), MSD (National Congress), and Gilead S.A. (International Congress); and participation on a Data Safety Monitoring Board or Advisory Board for Gilead S.A. (personal payment). M. T. has received grants from Janssen, Gilead, ViiV, and MSD; honoraria from Janssen, Gilead, ViiV, MSD, TheraTechnologies, and Shionogi for HIV and antimicrobial related presentations; and support for attending meetings and/or travel from ViiV and Gilead. J. M. has received honoraria for talks on behalf of MSD; Pfizer; Novartis; and Angelini. A. S. has received consulting fees and honoraria for talks on behalf of MSD; Pfizer; Novartis; Gilead; Shionogi; Menarini; and Angelini as well as grant support from Pfizer and Gilead, including support for attending meetings from Pfizer. D. S. reports support for attending meetings and/or travel from Pfizer (contribution to costs of events-registration fees). A. M. reports receipt of materials of laboratory from Gilead (reactive—IN-ES-540-6089). N. G.-P. reports support for attending meetings and/or travel from Gilead. R. A.-N. reports support for attending meetings and/or travel from Pfizer (contribution to costs of events-registrations fees). S. H. reports payment or honoraria for lectures, presentations, speaker’s bureaus, manuscript writing, or educational events from MSD and Shire, and support for attending meetings and/or travel from Pfizer. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.