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Remdesivir for Early COVID-19 Treatment in the Outpatient Setting

Data shown in the Pinetree clinical trial and being presented with 2 posters at CROI demonstrate both benefits and safety in preventing progression to more severe disease.

Since the beginning of the pandemic, clinicians have been looking for therapies to help those with mild COVID-19 from progressing to more severe disease requiring hospitalization, especially those who are at high risk of doing so.

Remdesivir has been studied in this patient population with the Pinetree study, and the results showed a “3-day course of remdesivir had an acceptable safety profile and resulted in an 87% lower risk of hospitalization or death than placebo,” according to the study’s authors whose findings were published in the New England Journal of Medicine.

“Antivirals work best when used early,” Robert Gottlieb, MD, PhD, FACC, Baylor Heart and Vascular Hospital, said. Gottlieb was the lead author on the Pinetree study. He explained the criteria for enrolling participants was 7 days since experiencing symptoms and 4 days since being diagnosed with a positive test.

He says the therapy can easily be administered outside of hospitals. “Remdesivir, although is [administered as an] IV, can be initiated in an outpatient setting; in fact, many of our patients received 1 or more doses at home or in a nonhospitalized setting,” Gottlieb said. 

In addition, 2 studies being presented at the 2022 Annual Conference on Retroviruses and Opportunistic Infection (CROI) examined the safety of remdesivir vs placebo in nonhospitalized patients, and another looked at the biomarkers for disease progression.

Contagion spoke to Gottlieb about the Pinetree study, the timing of when to begin the medication, considering at high-risk patients, and its safety profile.

The two CROI posters referenced in the article are the following: Remdesivir in an Outpatient Setting Improves Biomarkers for Progression of COVID-19 and Safety of Remdesivir vs Placebo in Nonhospitalized Patients With COVID-19.