Experience of Treating COVID-19 With Remdesivir and Convalescent Plasma in a Resource-Limited Setting: A Prospective, Observational Study
Janak Koirala, Pradip Gyanwali, Robert B. Gerzoff, Saroj Bhattarai, Bipin Nepal, Rekha Manandhar, Runa Jha, Sanjib Sharma, Yuba Raj Sharma, Anup Bastola, Holly Murphy, Subhash Prasad Acharya, Prabhat Adhikari, Manita Rajkarnikari, Karishma Malla Vaidya, Chhabi L. Panthi, Bihungum Bista, Grishma Giri, Shambhu Aryal, Suman Pant, Akritee Pokharel, Shristi Karki, Sangita Basnet, Bhagawan Koirala, Meghnath Dhimal, Roshan Kumar Jha, Anil Shrestha, Ashesh Dhungana, Shreejana Shrestha, Sarita Pandey, Sangita Shakya, Philip S Ranjit, Sunil Dhungel, Devendra Bhattarai, Sumitra Gautam, Pramod Poudel, Kalyan Sapkota, Khagendra J Shah, Rajesh Kumar Mandal, Rajan Kumar Pandey, Sumit Prajapati, Arif Hussain, Shakuntala Gupta, Roshan Chhetri, Krishna Pokharel, Kala Thapa, Shital Adhikari, Gopendra Prasad Deo, Basanta Gauli, Pukar Ghimire, Bishnu P. Regmi, Ram B. Gurung, Rajeev Shrestha, Dipesh Tamrakar, Sushil Khanal, Upasana Acharya, Suhail Sapkota, Reema Shrestha, Milesh Jung Sijapati, Smriti Koirala, Suraj Bajracharya, Deepak Sigdel, Den P Acharya, Sudarshan Chhetri, Prashanta Acharya, Hari Prasad Panthi, Ashesh Dhungana, Achyut Raj Karki, Ramesh Singh, Uday Narayan Singh, Rakesh Tiwari, Asraf Hussain, Rupesh Shah, Parwez A Ansari, Diptesh Aryal, Sanjit K Shrestha, Kanchan Koirala, Kiran Kumar KC, Bidur P Acharya, Shyam Kumar BK, Sumit Kumar Pandey, Suraj Gupta, Deepa Shakya, Yunima Sapkota, Anju Adhikari, Bishwanath Koirala, Bipin Karki, Yuba Raj Sharma, Bimal Pandey, Buddhi S Lamichhane, Sanjay Shrestha, Sher Bahadur Kamar, Ashok Chaudhary, Jagdish Chandra Joshi, Kunjang Sherpa, Reeju Manandhar, Chiranjibi Pant, Rinku Joshi, Anup Bastola, Bimal Sharma Chalise
Abstract
BACKGROUND: Convalescent plasma therapy (CPT) and remdesivir (REM) have been approved for investigational use to treat coronavirus disease 2019 (COVID-19) in Nepal. METHODS: In this prospective, multicentered study, we evaluated the safety and outcomes of treatment with CPT and/or REM in 1315 hospitalized COVID-19 patients over 18 years in 31 hospitals across Nepal. REM was administered to patients with moderate, severe, or life-threatening infection. CPT was administered to patients with severe to life-threatening infections who were at high risk for progression or clinical worsening despite REM. Clinical findings and outcomes were recorded until discharge or death. RESULTS: Patients were classified as having moderate (24.2%), severe (64%), or life-threatening (11.7%) COVID-19 infection. The majority of CPT and CPT + REM recipients had severe to life-threatening infections (CPT 98.3%; CPT + REM 92.1%) and were admitted to the intensive care unit (ICU; CPT 91.8%; CPT + REM 94.6%) compared with those who received REM alone (73.3% and 57.5%, respectively). Of 1083 patients with reported outcomes, 78.4% were discharged and 21.6% died. The discharge rate was 84% for REM (n = 910), 39% for CPT (n = 59), and 54.4% for CPT + REM (n = 114) recipients. In a logistic model comparing death vs discharge and adjusted for age, gender, steroid use, and severity, the predicted margin for discharge was higher for recipients of remdesivir alone (0.82; 95% CI, 0.79-0.84) compared with CPT (0.58; 95% CI, 0.47-0.70) and CPT + REM (0.67; 95% CI, 0.60-0.74) recipients. Adverse events of remdesivir and CPT were reported in <5% of patients. CONCLUSIONS: NCT04570982.