key: cord-0697151-feurpux5
authors: Bistrovic, Petra; Lucijanic, Marko
title: Remdesivir might induce changes in electrocardiogram beyond bradycardia in patients with coronavirus disease 2019—The pilot study
date: 2021-07-14
journal: J Med Virol
DOI: 10.1002/jmv.27177
sha: 3e1f2bee9ae01a303328c731c8ff9b0550afee85
doc_id: 697151
cord_uid: feurpux5

We comment on the recently published paper by Pallotto et al. (2021;93(5):2631-2634.) who reported transient bradicardia in COVID-19 patients treated with remdesivir. We present the results of our own pilot study of remdesivir induced changes in electrocardiogram of severe COVID-19 patients where T axis deviation was the most pronounced finding after remdesivir infusion. T wave axis deviation is associated with propensity for sudden cardiac death and non-fatal cardiovascular events among elderly in the general population. This article is protected by copyright. All rights reserved.

not yet recognized, patient subgroups which cancels out potential benefits of the drug in the overall cohort of patients. Remdesivir is a prodrug and one of its metabolites GS-443902 is an adenosine analog but with a substantially longer elimination half-life than adenosine. 3 Adenosine has known antiarrhythmic effects in atrioventricular-nodal re-entry tachycardias but can be proarrhythmic in patients with structural heart disease. 4, 5 Several small postmarketing studies and case reports reported cardiovascular sideeffects of remdesivir including bradycardia, hypotension, QTc interval prolongation, nonspecific T-wave changes, and cardiac arrest. [6] [7] [8] [9] Prompted by the study by Palloto et al. 1 The T-axis deviation is a strong and independent risk indicator of sudden cardiac death, cardiac death, and nonfatal cardiac events in the elderly. 10, 11 Whether this finding and in what extent translates into detrimental clinical outcomes in severe COVID-19 patients treated with remdesivir remains to be elucidated in future studies that are highly needed. No firm conclusions regarding this issue can be drawn from our data at the moment.

Elderly patients with a high comorbidity burden that do not fit strict original clinical-trial criteria are often exposed to the drug in the real-life setting. It should be noted that due to the scale of the COVID-19 pandemic, severity of the health hazard imposed on affected individuals and strain put on the healthcare systems, there is a low quality of adverse event reporting in remdesivir clinical trials. 12 Adverse effects of the drug might be more common than reported and attributed to the disease course itself. Nevertheless, understanding the true efficacy and safety profile of the drug is the imperative for improving outcomes of patients with severe COVID-19.

Potential remdesivir-related transient bradycardia in patients with coronavirus disease 2019 (COVID-19)

Remdesivir for the treatment of Covid-19-Final report

Pharmacodynamic, and Drug-Interaction Profile of Remdesivir, a SARS-CoV-2 Replication Inhibitor

A wide QRS complex tachycardia following intravenous adenosine

Case report: adenosine induced ventricular fibrillation in a patient with stable ventricular tachycardia

Cardiac adverse events with remdesivir in COVID-19 infection

Serious bradycardia and remdesivir for coronavirus 2019 (COVID-19): a new safety concerns

Compassionate use of remdesivir for patients with severe Covid-19

Marked sinus bradycardia associated with remdesivir in COVID-19: a case and literature review

Usefulness of T-axis deviation as an independent risk indicator for incident cardiac events in older men and women free from coronary heart disease (the Cardiovascular Health Study)

T axis as an indicator of risk of cardiac events in elderly people

Quality of adverse event reporting in clinical trials of remdesivir in patients with COVID-19

T A B L E 1 ECG characteristics of 14 patients with severe COVID-19 before remdesivir application and 2 h after the end of remdesivir infusion