A real-life setting evaluation of the effect of remdesivir on viral load in COVID-19 patients admitted to a large tertiary centre in Israel

Abstract

Objectives: The effectiveness of remdesivir, a Food and Drug Administration-approved drug for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has been repeatedly questioned during the current coronavirus disease 2019 (COVID-19) pandemic. Most of the recently reported studies were randomized controlled multicentre clinical trials. Our goal was to test the efficiency of remdesivir in reducing nasopharyngeal viral load and hospitalization length in a real-life setting in patients admitted to a large tertiary centre in Israel.

Methods: A total of 142 COVID-19 patients found to have at least three reported SARS-CoV-2 quantitative RT-PCR tests during hospitalization were selected for this study. Of these, 29 patients received remdesivir, while the remaining non-treated 113 patients served as controls.

Results: Among the tested parameters, the control and remdesivir groups differed significantly only in the intubation rates. Remdesivir treatment did not significantly affect nasopharyngeal viral load, as determined by comparing the differences between the first and last cycle threshold values of the SARS-CoV-2 quantitative RT-PCR tests performed during hospitalization (cycle threshold 7.07 ± 6.85 vs. 7.08 ± 7.27, p 0.977 in the control and treated groups, respectively). Remdesivir treatment shortened hospitalization length by less than a day compared with non-treated controls and by 3.1 days when non-intubated patients from both groups were compared. These differences, however, were not statistically significant, possibly because of the small size of the remdesivir group.

Discussion: Remdesivir was not associated with nasopharyngeal viral load changes, but our study had a significant disease severity baseline imbalance and was not powered to detect viral load or clinical differences.

Keywords: Coronavirus disease 2019 (COVID-19); Hospitalization length; Remdesivir; SARS-CoV-2; Viral load.

Fig. 1

Ct values from control and remdesivir-treated patients. First, middle and last Ct values (A,B,C, respectively) from the nucleocapsid gene from control and remdesivir treated patients were compared (n = 142). The difference (Δ) between the indicated test Ct values is shown (A, B, C, p 0.977, p 0.362, p 0.228, respectively, unpaired Student's t-test). The Ct values of the first and last test in the control or remdesivir-treated patients are shown both for all patients (D, first p 0.365, last p 0.109, unpaired Student's t-test) or non-intubated patients only (E, first p 0.203, last p 0.088, unpaired Student's t-test). ns, non-significant.

Fig. 2

Hospitalization length in remdesivir treated patients and controls. Time in days from the first recorded test to discharge in all control and remdesivir-treated patients (A, p 0.769, unpaired Student's t-test) or non-intubated patients only (B, p 0.3, unpaired Student's t-test).