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New Drug Reviews

Remdesivir (Veklury) for the Treatment of COVID-19 in Hospitalized Patients

 

Am Fam Physician. 2021 Sep ;104(2):311-312.

Remdesivir (Veklury) is an antiviral drug that inhibits the replication of pathogenic human coronaviruses, including SARS-CoV-2 and SARS-CoV-1.1 Remdesivir is approved by the U.S. Food and Drug Administration for the treatment of COVID-19 in adults, and it can be given to children 12 years and older (weighing at least 88 lb [40 kg]) or younger than 12 years (weighing at least 7.7 lb [3.5 kg]) under an emergency use authorization.2

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DrugStarting dosageDose formCost*

Remdesivir (Veklury)

Patients 12 years and older: 200 mg on day 1 via intravenous infusion, followed by 100 mg once daily for five to 10 days based on the need for respiratory support Children younger than 12 years weighing 88 lb (40 kg) or more: 200 mg on day 1 via intravenous infusion, followed by 100 mg once daily for five to 10 days based on the need for respiratory support Infants and children weighing 7.7 lb (3.5 kg) to less than 88 lb: 5 mg per kg on day 1 via intravenous infusion, followed by 2.5 mg per kg once daily for five to 10 days based on the need for respiratory support

12 years and older: 100-mg powder in a single-dose vial or 100 mg per 20 mL of solution in a single-dose vial Younger than 12 years: 100-mg powder in a single-dose vial only

$3,120 per treatment


*—Estimated private insurance price for one treatment.12 Actual cost will vary with insurance and by region. Information obtained at https://www.ajmc.com/view/gilead-sciences-sets-us-price-for-covid19-drug-at-2340-to-3120-based-on-insurance (accessed May 26, 2021; zip code: 66211).

DrugStarting dosageDose formCost*

Remdesivir (Veklury)

Patients 12 years and older: 200 mg on day 1 via intravenous infusion, followed by 100 mg once daily for five to 10 days based on the need for respiratory support Children younger than 12 years weighing 88 lb (40 kg) or more: 200 mg on day 1 via intravenous infusion, followed by 100 mg once daily for five to 10 days based on the need for respiratory support Infants and children weighing 7.7 lb (3.5 kg) to less than 88 lb: 5 mg per kg on day 1 via intravenous infusion, followed by 2.5 mg per kg once daily for five to 10 days based on the need for respiratory support

12 years and older: 100-mg powder in a single-dose vial or 100 mg per 20 mL of solution in a single-dose vial Younger than 12 years: 100-mg powder in a single-dose vial only

$3,120 per treatment


*—Estimated private insurance price for one treatment.12 Actual cost will vary with insurance and by region. Information obtained at https://www.ajmc.com/view/gilead-sciences-sets-us-price-for-covid19-drug-at-2340-to-3120-based-on-insurance (accessed May 26, 2021; zip code: 66211).

Safety

Based on data from three phase 3 studies that included 1,313 patients, the most common adverse effects leading to discontinuation of treatment are infusion-related hypersensitivity reactions, which occur in less than 1% of patients.2,3 Remdesivir should not be used in patients with an estimated glomerular filtration rate (GFR) of less than 30 mL per minute and should be discontinued if the estimated GFR decreases to less than 30 mL per minute. Because remdesivir may affect liver function, patients should be monitored. If alanine transaminase levels increase to more than 10 times the upper limit of normal, treatment must be discontinued. Remdesivir should also be discontinued if the patient exhibits signs and symptoms of liver inflammation, acute kidney injury with decreased GFR, and decreased heart rate.3

Address correspondence to Shyam Odeti, MD, FAAFP, SFHM, MBA, at dr.odeti@gmail.com. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

1. Wang Y, Zhang D, Du G, et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial [published correction appears in Lancet. 2020;395(10238):1694]. Lancet. 2020;395(10236):1569–1578....

2. DailyMed. Drug label information. Veklury—remdesivir injection, powder, lyophilized, for solution. Accessed June 23, 2021. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c0978fa8-53ff-4ca2-82a7-567fd3e958ca#S5.1

3. Beigel JH, Tomashek KM, Dodd LE, et al.; ACTT-1 Study Group Members. Remdesivir for the treatment of Covid-19 - final report. N Engl J Med. 2020;383(19):1813–1826.

4. Goldman JD, Lye DCB, Hui DS, et al.; GS-US-540-5773 Investigators. Remdesivir for 5 or 10 days in patients with severe Covid-19. N Engl J Med. 2020;383(19):1827–1837.

5. Bhimraj A, Morgan RL, Shumaker AH, et al. IDSA guidelines on the treatment and management of patients with COVID-19. Infectious Diseases Society of America 2021; Version 4.1.1. Accessed April 12, 2021. https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/

6. Pan H, Peto R, Henao-Restrepo AM, et al.; WHO Solidarity Trial Consortium. Repurposed antiviral drugs for Covid-19 - Interim WHO Solidarity Trial results. N Engl J Med. 2021;384(6):497–511.

7. Spinner CD, Gottlieb RL, Criner GJ, et al.; GS-US-540-5774 Investigators. Effect of remdesivir vs standard care on clinical status at 11 days in patients with moderate COVID-19: a randomized clinical trial. JAMA. 2020;324(11):1048–1057.

8. National Institutes of Health. COVID-19 treatment guidelines. Therapeutic management of hospitalized adults with COVID-19. Updated July 8, 2021. Accessed July 14, 2021. https://www.covid19treatmentguidelines.nih.gov/therapeutic-management/

9. Rochwerg B, Agarwal A, Siemieniuk RA, et al. A living WHO guideline on drugs for covid-19. BMJ. 2020;370:m3379.

10. Siemieniuk RA, Bartoszko JJ, Ge L, et al. Drug treatments for covid-19: living systematic review and network meta-analysis [published correction appears in BMJ. 2021;373:n967]. BMJ. 2020;370:m2980.

11. Inserro A. Gilead Sciences sets US price for COVID-19 drug at $2340 to $3120 based on insurance. Am J Manag Care. June 29, 2020. Accessed May 26, 2021. https://www.ajmc.com/view/gilead-sciences-sets-us-price-for-covid19-drug-at-2340-to-3120-based-on-insurance

12. U.S. Department of Health and Human Services. CARES Act Provider Relief Fund. Last reviewed January 21, 2021. Accessed June 28, 2021. https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/index.html

STEPS new drug reviews cover Safety, Tolerability, Effectiveness, Price, and Simplicity. Each independent review is provided by authors who have no financial association with the drug manufacturer.

The series coordinator for AFP is Allen F. Shaughnessy, PharmD, MMedEd, assistant medical editor.

A collection of STEPS published in AFP is available at https://www.aafp.org/afp/steps.

 

 

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