Is Remdesivir OK for COVID Patients With Severe Renal Impairment? - Medpage Today | Canada News Media
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Is Remdesivir OK for COVID Patients With Severe Renal Impairment? – Medpage Today

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Antiviral remdesivir (Veklury) appeared safe for hospitalized COVID-19 patients with severe kidney dysfunction, according to a secondary analysis of the CATCO trial.

In the analysis of the 59 patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2 at study randomization, no increased risk for hospital death was identified among those treated with remdesivir rather than standard of care (40.6% vs 52%, respectively; relative risk [RR] 0.78, 95% CI 0.41-1.49), reported Srinivas Murthy, MD, CM, MHSc, of the University of British Columbia in Vancouver, and colleagues.

This held true in a model that adjusted for sex and baseline eGFR as well (odds ratio [OR] 0.74, 95% CI 0.23-2.40), the group noted in a research letter in JAMA Network Open.

Need for new mechanical ventilation or incidence of any adverse events also trended lower in patients treated with remdesivir:

  • New mechanical ventilation: RR 0.57 (95% CI 0.15-1.80)
  • Adverse event: RR 0.37 (95% CI 0.05-1.33)

Furthermore, total average length of hospital stay wasn’t significantly different between the groups (23.1 days for remdesivir vs 21.6 for standard of care).

In this group of hospitalized patients with severe renal impairment, remdesivir also appeared to be safe for the kidneys, without any additional risk of transaminitis or toxic kidney effects by day 5:

  • Day 5 eGFR: 31.2 mL/min/1.73 m2 for remdesivir vs 20.5 mL/min/1.73 m2
  • Day 5 creatinine: 2.83 mg/dL for remdesivir vs 4.12 mg/dL
  • Day 5 alanine aminotransferase: 40.8 for remdesivir vs 91.9

For patients who didn’t require dialysis at baseline, the need for new dialysis was also no different for those given remdesivir (RR 0.95, 95% CI 0.25-3.56).

“These findings suggest that remdesivir can be safely administered in patients with kidney dysfunction, balancing possible risks and benefits,” Murthy’s group said, while noting the small study population as a limitation.

This is particularly reassuring as remdesivir is not currently recommended for use in patients with severe renal dysfunction, particularly those with an eGFR below 30, “owing to the presence of excipients that may accumulate in kidney dysfunction and worsen kidney or hepatic outcomes,” the researchers wrote.

They added that the “need for assessing kidney function in the absence of clinical suspicion before and during outpatient administration of remdesivir can be questioned.”

Data for the analysis came from the Canadian Treatments for COVID-19 (CATCO) trial that was part of the larger global Solidarity Trial. This trial didn’t impose any kidney-specific exclusion criteria to participation.

Patients randomized to receive open-label remdesivir were administered lyophilized remdesivir, diluted and administered intravenously with a loading dose of 200 mg on the first day, and then followed by daily 100-mg doses for 9 days or until the patient was discharged. The dose of remdesivir was not adjusted for baseline kidney functioning.

Standard of care was delivered in the form of “best-quality supportive care,” the team noted.

Along with the small study population (34 patients in the remdesivir group and 25 in the standard-of-care group), the current analysis was also limited by baseline differences, according to the researchers.

Between the remdesivir and control groups, respectively, baseline differences included median age (74 vs 80 years), male sex (38.2% vs 68%), median frailty score (4 vs 5), need for intensive care (32.4% vs 28%) or oxygen (47.1% vs 56%), as well as median creatinine (2.62 vs 3.88 mg/dL) and eGFR levels (22.7 vs 12.4 mL/min/1.73 m2), among others.

  • Kristen Monaco is a staff writer, focusing on endocrinology, psychiatry, and nephrology news. Based out of the New York City office, she’s worked at the company since 2015.

Disclosures

The study was funded by the Canadian Institutes of Health Research.

Murthy reported a relationship with the Canadian Institutes of Health Research; other co-authors also reported disclosures.

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How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

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HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.

The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.

Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.

“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”

The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.

A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.

Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.

“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.

Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.

The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.

“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.

This report by The Canadian Press was first published Sept. 11, 2024.

The Canadian Press. All rights reserved.

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Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

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ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.

Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.

Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.

Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.

The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.

“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.

Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.

Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.

Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.

A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.

This report by The Canadian Press was first published Sept. 10, 2024.

The Canadian Press. All rights reserved.

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