key: cord-0848696-rq3hs180
authors: Colaneri, Marta; Amarasinghe, Nicolò; Rezzonico, Leonardo; Pieri, Teresa Chiara; Segalini, Emilio; Sambo, Margherita; Roda, Silvia; Meloni, Federica; Gregorini, Marilena; Rampino, Teresa; Pelenghi, Stefano; Ricciardi, Alessandra; Bruno, Raffaele
title: Early Remdesivir to prevent severe COVID-19 in solid organ transplant recipients: a real-life study from Northern Italy
date: 2022-05-06
journal: Int J Infect Dis
DOI: 10.1016/j.ijid.2022.05.001
sha: 6207ed8db86f2aa3066f896f5424b7784d97501b
doc_id: 848696
cord_uid: rq3hs180

OBJECTIVES: The effectiveness of 3-days course remdesivir to prevent severe disease in COVID-19 solid organ transplant (SOT) recipients is unknown. We wanted to study the efficacy of this therapeutic option in COVID-19 SOT recipients in preventing both hospitalisations, if outpatients, and clinical worsening due to COVID-19, if already hospitalised for other reasons. METHODS: This is a single-centre, retrospective, observational study conducted in the Fondazione IRCSS Policlinico San Matteo of Pavia, Northern Italy. We extracted all the data of COVID-19 SOT recipients who received and did not receive pre-emptive remdesivir between 23 December 2021 and 26 February 2022. We used a Cox proportional hazard model to assess whether receiving pre-emptive remdesivir was associated with lower rates of hospitalisation. RESULTS: Twenty-four SOT patients were identified. Among these, seven patients (29,1%) received pre-emptive remdesivir, whereas 17 (70,9%) patients did not. Receiving remdesivir significantly reduced the hospitalisation rate in SOT outpatients and the clinical worsening of already hospitalised SOT patients (HR 0.05; CI [0.00–0.65] p = 0.01). CONCLUSION: In our cohort of SARS-CoV-2 infected SOT recipients, pre-emptive remdesivir was effective in reducing the hospitalisation rate due to COVID-19 and in preventing the clinical worsening of the SOT patients hospitalized for reasons other than COVID-19.

disease in COVID-19 solid organ transplant (SOT) recipients is unknown. We 27 wanted to study the efficacy of this therapeutic option in COVID-19 SOT recipients in 28 preventing both hospitalisations, if outpatients, and clinical worsening due to 19, if already hospitalised for other reasons. 30

Methods: This is a single-centre, retrospective, observational study conducted in the 31

Fondazione IRCSS Policlinico San Matteo of Pavia, Northern Italy. We extracted all 32 the data of COVID-19 SOT recipients who received and did not receive pre-emptive 33 remdesivir between 23 December 2021 and 26 February 2022. We used a Cox 34

proportional hazard model to assess whether receiving pre-emptive remdesivir was 35 associated with lower rates of hospitalisation. 36

Results: Twenty-four SOT patients were identified. Among these, seven patients 37 (29,1%) received pre-emptive remdesivir, whereas 17 (70,9%) patients did not. According to the Agenzia Italiana del Farmaco (AIFA) (1), the administration of 3-83 days remdesivir was not recommended in patients with eGFR <30 mL/minute and 84 onset symptom > 7 days. We also excluded patients who were treated with pre-85 emptive treatments other than remdesivir, allowing a direct comparison between 86 patients who did and did not receive the drug. The authors declare that they have no known competing financial interests or personal 159 relationships that could have appeared to influence the work reported in this paper. 160 161

al Remdesivir for the Treatment of Covid-19 -Final Report

COVID-19 Treatment Guidelines: Clinical Spectrum of SARS-CoV-2 Infection 169 Avaible on: 170

Outcomes of SOT Recipients With 179

COVID-19 in Different Eras of COVID-19 Therapeutics

Drug treatments for covid-19: living systematic review and network meta-analysis

Statement on Patient Prioritization for Outpatient Therapies

COVID-185 19 Treatment Guidelines

Remdesivir for Adults With COVID-19 : A Living Systematic Review for American 190

College of Physicians Practice Points

Cox regression model show reduced hospital admission at 28 days from 195 the positivization of RT-PCR nasal swab for SARS-CoV-CoV-2 in Cox regression 196 model 197

With regard to remdesivir pre-emptive therapy, 7 patients (29,1%) were treated with 113 this drug, while 17 (70,9%) patients were not. Among these latter, 5 had CKD (egfr < 114 30 ml/min, but none was in chronic dialysis replacement), while 12 were 115 asymptomatic at the time of COVID-19 diagnosis.