Remdesivir in Patients with Acute or Chronic Kidney Disease and COVID-19

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Figure 1.
Mechanism of action of remdesivir. Remdesivir triphosphate leads to delayed chain termination after three additional bases have been added.

Table 1.

Summary of available clinical trial data

Trial Name/NCT No.	Study Design	N, Population	eGFR Cutoff	Remdesivir Duration, d	Outcomes
NIAID ACTT-1 study	Double-blind, placebo-controlled RCT	1063 hospitalized adult patients, international	30	10	Interim analysis: median time to recovery 11 versus 15 d; P<0.001; mortality 8% versus 11.6%; P=0.06
NCT04292899	Randomized, open-label trial	197 adults with severe COVID-19, international	50	5 versus 10	70% clinical recovery and 59% clinical recovery by 14 d in 5- and 10-d groups
Compassionate use program	Open label, multicenter, nonrandomized	>1200 adults, 76 children with COVID-19, international	30	10	Report of 61 treated patients, 8 lost to follow-up; 36 of 53 improved at a median follow-up of 18 d²
NCT04257656	Double-blind, placebo-controlled RCT	237 adults with severe COVID-19, China	30	10	No difference in time to clinical improvement; equivalent number of renal AEs in placebo and remdesivir arms³

In all cases, remdesivir dosing begins with a 200-mg intravenous loading dose followed by 100 mg intravenously daily. Currently available clinical trial data supporting remdesivir use are shown. NCT, national clinical trial; NIAID ACTT-1, National Institute of Allergy and Infectious Diseases Adaptive Covid-19 Treatment Trial; RCT, randomized, controlled trial; AE, adverse event.