Remdesivir in adults with COVID-19 did not reduce major adverse cardiovascular event risk
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Key takeaways:
- Rate of major adverse cardiovascular events between 30 days and 18 months was 2.54 events per 100 patient-months.
- Patients on remdesivir had attenuation of eGFR decline vs. historical comparators.
Use of remdesivir in hospitalized patients with COVID-19 and reduced eGFR did not decrease the risk of major adverse cardiovascular events or major adverse kidney disease.
Patients who received remdesivir had a less steep decline in eGFR compared with historical comparators during 18 months, researchers noted in the published data.
“Acute and chronic kidney disease are important risk factors for hospitalization and death from [COVID-19],” James E. Dinulos, BA, of the Massachusetts General Hospital nephrology division in Boston, wrote with colleagues. “In addition to acute complications of COVID-19, survivors may experience a wide range of persistent symptoms, collectively referred to as ‘long COVID,’ and are at an increased risk of cardiovascular and kidney post-acute sequelae, including myocardial infarction, heart failure, thromboembolic disease and kidney failure.”
Researchers compared the risk of major adverse cardiovascular events (MACEs) or major adverse kidney disease and sought to determine if remdesivir was linked to differences in long-term outcomes, such as morbidity and mortality.
The study included 200 patients with admission eGFR below 60 mL/min/1.73 m2 who had remdesivir and 555 potential historical comparators. A close match was found for 198 remdesivir-treated patients who were matched to 335 historical comparators.
Of the matched cohorts, 81.8% of patients treated with remdesivir and 74.6% historical comparators survived more than 30 days. Pairs with a matched patient on remdesivir and at least one historical comparator who survived more than 30 days were the primary cohort for analysis. Mean age was 71 years, and many patients had comorbid conditions including diabetes, hypertension and coronary artery disease.
Researchers found the rate of MACEs between 30 days and 18 months was 2.54 events per 100 patient-months, while major adverse kidney disease incidence was 0.74 events per 100 patient-months. Researchers found no significant difference in MACEs or major adverse kidney disease between the groups. However, patients who received remdesivir experienced a significant attenuation of eGFR decline vs. historical comparators.
“Our study is in line with prior studies showing that the rate of MACEs is high in patients with COVID-19,” according to the researchers. “ ... Additionally, adverse kidney outcomes were more common in patients with COVID-19; 30-day survivors of COVID-19 exhibited higher risk of [AKI], 50% eGFR decline and kidney failure.”
Further, Dinulos and colleagues wrote, “COVID-19 can trigger collapsing glomerulopathy in patients with high-risk APOL1 genotype and has poor long-term outcomes. Understanding whether treatments for COVID-19 reduce long COVID-19 is an important unmet need.”
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