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Remdesivir: treatment of COVID-19 in special populations

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Abstract

Remdesivir (RDV) is the mainstay antiviral therapy for moderate to severe COVID-19. Although remdesivir was the first drug approved for COVID-19, information about its efficacy and safety profile is limited in a significant segment of the population, such as people with underlying diseases, the elderly, children, and pregnant and lactating women. The efficacy and safety profile of RDV in disease progression, renal impairment, liver impairment, immunosuppression, geriatrics, pediatrics, pregnancy, and breastfeeding in COVID-19 patients was evaluated. The databases searched included Embase, Scopus, and PubMed. Only English language studies enrolling specific subpopulations with COVID-19 and treated with RDV were included. Thirty-nine clinical trials, cohorts, cross-sectional studies, and case series/reports were included. Most supported the benefits of RDV therapy for COVID-19 patients, such as lessening the duration of hospitalization, alleviating respiratory complications, and reducing mortality. Adverse effects of RDV, including liver and kidney impairment, were, for the most part, moderate to mild, supporting the safety profile of RDV therapy. RDV therapy was well tolerated, no new safety signals were detected, and liver function test abnormalities were the most common adverse events. Moreover, RDV, for the most part, was effective in managing the complications of COVID-19 and reducing mortality in these patients, except for patients with kidney impairment. Future studies, including RCTs, should include these subpopulations of patients to avoid delays associated with receiving proper medication through compassionate use programs.

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Data availability

The datasets/information used for this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors thank Mashhad University of Medical Sciences, Iran.

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Authors and Affiliations

  1. Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

    Emad Molaei

  2. Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

    Ali Molaei

  3. University of South Florida College of Public Health, Tampa, FL, USA

    A. Wallace Hayes

  4. Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, USA

    A. Wallace Hayes

  5. Pharmaceutical Research Center, Institute of Pharmaceutical Technology, Mashhad University of Medical Sciences, Mashhad, Iran

    Gholamreza Karimi

  6. Department of Pharmacodynamics and Toxicology, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran

    Gholamreza Karimi

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EM and AM performed the literature searches and data extraction and drafted parts of the manuscript. AWH revised the manuscript for critical intellectual content. GK conceptualized the work, supervised the project, and revised the manuscript for critical intellectual content. The authors confirm that no paper mill and artificial intelligence was used.

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Molaei, E., Molaei, A., Hayes, A.W. et al. Remdesivir: treatment of COVID-19 in special populations. Naunyn-Schmiedeberg's Arch Pharmacol 397, 3829–3855 (2024). https://doi.org/10.1007/s00210-023-02927-2

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  • DOI: https://doi.org/10.1007/s00210-023-02927-2

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