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. 2020 Oct 20;64(11):e01521-20.
doi: 10.1128/AAC.01521-20. Print 2020 Oct 20.

Removal of Remdesivir's Metabolite GS-441524 by Hemodialysis in a Double Lung Transplant Recipient with COVID-19

Minh Patrick Lê  1   2 , Quentin Le Hingrat  3   4 , Pierre Jaquet  5 , Paul-Henri Wicky  5 , Vincent Bunel  6 , Laurent Massias  7   4 , Benoit Visseaux  3   4 , Jonathan Messika  6 , Diane Descamps  3   4 , Hervé Mal  6 , Jean-François Timsit  4   5 , Gilles Peytavin  7   4
Affiliations

Removal of Remdesivir's Metabolite GS-441524 by Hemodialysis in a Double Lung Transplant Recipient with COVID-19

Minh Patrick Lê et al. Antimicrob Agents Chemother. .

Abstract

Remdesivir has reported efficacy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro and in vivo Drug-drug interactions limit therapeutic options in transplant patients. Remdesivir and its metabolite GS-441524 are excreted principally in urine. In intensive care unit (ICU) settings, in which multiple-organ dysfunctions can occur rapidly, hemodialysis may be a viable option for maintaining remdesivir treatment, while improving tolerance, by removing both remdesivir's metabolite (GS-441524) and sulfobutylether β-cyclodextrin sodium (SEBCD). Additional studies may prove informative, particularly in the evaluations of therapeutic options for coronavirus disease 2019 (COVID-19).

Keywords: hemodialysis; pharmacokinetics; remdesivir.

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Figures

FIG 1
FIG 1
Timeline of the clinical endpoints, immunomodulation therapy, and antimicrobial chemotherapy for our patient. AMC, amoxicillin-clavulanic acid; CS, corticosteroid pulses; DXM, dexamethasone; ISA, isavuconazole; MPA, mycophenolate; RDV, remdesivir; SXT, sulfamethoxazole-trimethoprim; TZP, piperacillin-tazobactam; VAL, valganciclovir.
FIG 2
FIG 2
Biotransformation of remdesivir (inactive prodrug) into GS-441524 and then GS-443902 (active metabolite, triphosphate analogue).
See this image and copyright information in PMC

Comment in

References

    1. Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, Ruan L, Song B, Cai Y, Wei M, Li X, Xia J, Chen N, Xiang J, Yu T, Bai T, Xie X, Zhang L, Li C, Yuan Y, Chen H, Li H, Huang H, Tu S, Gong F, Liu Y, Wei Y, Dong C, Zhou F, Gu X, Xu J, Liu Z, Zhang Y, Li H, Shang L, Wang K, Li K, Zhou X, Dong X, Qu Z, Lu S, Hu X, Ruan S, Luo S, Wu J, Peng L, Cheng F, Pan L, Zou J, Jia C, et al. . 2020. A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. N Engl J Med 382:1787–1799. doi:10.1056/NEJMoa2001282. - DOI - PMC - PubMed
    1. Mehra MR, Ruschitzka F, Patel AN. 2020. Retraction—Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet 395:1820. doi:10.1016/S0140-6736(20)31324-6. - DOI - PMC - PubMed
    1. Murthy S, Gomersall CD, Fowler RA. 2020. Care for critically ill patients with COVID-19. JAMA 323:1499. doi:10.1001/jama.2020.3633. - DOI - PubMed
    1. Avataneo V, de Nicolò A, Cusato J, Antonucci M, Manca A, Palermiti A, Waitt C, Walimbwa S, Lamorde M, di Perri G, D’Avolio A. 2020. Development and validation of a UHPLC-MS/MS method for quantification of the prodrug remdesivir and its metabolite GS-441524: a tool for clinical pharmacokinetics of SARS-CoV-2/COVID-19 and Ebola virus disease. J Antimicrob Chemother 75:1772–1777. doi:10.1093/jac/dkaa152. - DOI - PMC - PubMed
    1. Cao Y-C, Deng Q-X, Dai S-X. 2020. Remdesivir for severe acute respiratory syndrome coronavirus 2 causing COVID-19: an evaluation of the evidence. Travel Med Infect Dis 35:101647. doi:10.1016/j.tmaid.2020.101647. - DOI - PMC - PubMed

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