Abstract
Information regarding Coronavirus disease 2019 in the transplant population is lacking. Recently it has been suggested that cycle threshold values obtained on polymerase chain reaction tests may serve as a marker of disease severity with lower values (i.e., higher viral load) being associated with higher mortality. This study was done to assess the impact of remdesivir use on the time to a negative COVID-19 PCR as well as the degree of change between two Ct’s based on treatment. A total of 30 kidney transplant patients with a new diagnosis of COVID-19 were assessed. Serial PCR results were followed from the time of diagnosis then every 2–4 weeks until negative. In patients who received remdesivir immediately after COVID-19 confirmation compared to no remdesivir, time to negative PCR was not statistically different with a median duration of 57 days in both groups (p = 0.369). The change in the Ct between the first and the second PCR test was also not statistically different between groups with a median change of 18.4 cycles in the remdesivir group and 15.7 cycles without remdesivir (p = 0.516). The results of this small single-center analysis suggest that remdesivir may not be beneficial in shortening time to a negative COVID-19 PCR.
Highlights
Coronavirus disease 2019 (COVID-19) has an increased incidence and risk of severe infection among immunocompromised patients [1]
It has been suggested that cycle threshold values (Ct) obtained on polymerase chain reaction (PCR) tests may serve as a marker of disease severity with lower values being associated with higher mortality [4]
In patients who received remdesivir immediately after COVID-19 confirmation compared to no remdesivir, the time to negative PCR was not statistically different with a median duration of 57 days in both groups (p = 0.369)
Summary
Coronavirus disease 2019 (COVID-19) has an increased incidence and risk of severe infection among immunocompromised patients [1]. Transplant patients are known to frequently have delayed clearance or prolonged shedding of respiratory viruses [2]. With this in mind, therapy that may reduce the severity and/or duration of illness are crucial. It has been suggested that cycle threshold values (Ct) obtained on polymerase chain reaction (PCR) tests may serve as a marker of disease severity with lower values (i.e., higher viral load) being associated with higher mortality [4]. This letter describes our center’s experience with using remdesivir and/or reduced anti-metabolite dosing in an attempt to expedite clearance of the virus, as indirectly measured by serial PCR Ct testing. Patients with severe leukopenia (WBC < 3.0) were treated with elimination of anti-metabolite while the remainder received a 50% reduction in anti-metabolite dose [6]
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