Clinical safety of remdesivir therapy in COVID-19 patients with renal insufficiency.

배경: Despite the known clinical benefit of remdesivir in SARS-CoV-2 infection, its usage has been limited in patients with impaired renal function due to concern about the liver and renal toxicities by the accumulation of sulfobutylether-β-cyclodextrin. We compared adverse events between remdesivir-treated and non-remdesivir-treated groups in COVID-19 patients with renal impairment. 방법: Adult COVID-19 patients with a glomerular filtration rate of <30 ml/min/1.73 m2 at admission to a tertiary care hospital between November 2020 and March 2022 were retrospectively enrolled. Data on serum creatinine and liver chemistry tests at day 3 or 5, 10, 15, and 30 from admission or the start of remdesivir therapy were collected. 결과: A total of 101 patients with impaired renal function were enrolled including 34 patients receiving renal replacement therapy. Of 101 patients, 64 received remdesivir, while 37 did not. The median duration of remdesivir therapy was 4 (interquartile range, 3-5). Among patients who did not need dialysis initially, 18% (7/38) of remdesivir-treated patients developed acute kidney injury (AKI) at day 3-5, while 43% (16/29) of non-remdesivir-treated patients did. The proportion of patients with AKI decreased over time in remdesivir-treated patients (Figure 1). At day 3-5, 20% (13/64) of remdesivir-treated patients developed liver injury (mostly mild injury), while 30% (11/37) of non-remdesivir-treated patients did. There was no significant increase in alanine aminotransferase level over time in remdesivir-treated patients (Figure 1). No serious renal and hepatic adverse events related to remdesivir were observed. 결론: No significant increases in liver and kidney injury associated with remdesivir therapy were observed. These findings suggest that remdesivir therapy should not be easily withheld due to safety concerns of sulfobutylether-β-cyclodextrin in COVID-19 patients with renal impairment. [ABSTRACT FROM AUTHOR]