Remdesivir kidney transplant study links COVID treatment to lower risks
A Johns Hopkins study found early remdesivir after COVID-19 was associated with lower graft-loss and cardiovascular risks in adult kidney transplant recipients.
By Tom Brennan · Health & Medicine Correspondent
3 min read
A remdesivir kidney transplant study in JAMA Network Open found that adult kidney transplant recipients treated early for COVID-19 had better one-year outcomes than similar patients who did not receive the antiviral. Johns Hopkins University School of Medicine said the findings may help physicians weigh remdesivir use in a group often left out of randomized trials because of medical risks.
The study examined adults with kidney transplants who were diagnosed with COVID-19 from March 2020 through January 2024 and treated at five Johns Hopkins Medicine hospitals in Maryland. Researchers used a target trial emulation, described by the team as a simulated trial, to compare patients who received remdesivir with those who did not.
Remdesivir is an antiviral medication given intravenously, according to the study description. In this analysis, treatment meant at least three consecutive days of remdesivir started within one week of a COVID-19 diagnosis.
What did the remdesivir kidney transplant study find?
Among 432 adult kidney transplant recipients, Johns Hopkins researchers reported that 177 patients, or 41%, received early remdesivir and 255, or 59%, did not. Patients who received other COVID-19 treatments, including monoclonal antibodies and other antivirals, were excluded from the analysis.
The main outcome was all-cause graft loss, defined by the investigators as kidney transplant failure or death from any cause. The researchers also assessed cardiovascular complications, death from any cause and long COVID during follow-up of up to one year.
After adjusting for differences including age, underlying illnesses, medications, COVID-19 severity, transplant timing, vaccination status and the time period of diagnosis, the study found early remdesivir was associated with a 47% lower risk of all-cause graft loss compared with no remdesivir. The team also reported a 42% lower risk of cardiovascular events, such as heart attack, stroke or cardiac-related death.
The researchers found a trend toward lower death risk, but said the association was not statistically significant. The long COVID analysis was inconclusive because few patients had documented long COVID, according to Johns Hopkins.
Who was included in the analysis?
The study population had substantial health risks, according to the Johns Hopkins report. Among all 432 patients, 48, or 11%, had all-cause graft loss; 43, or 10%, had a cardiovascular complication; 35, or 8%, died from any cause; and 17, or 4%, had long COVID.
Johns Hopkins said 88 adults, or 20%, needed supplemental oxygen at diagnosis. The group also included 413 patients with high blood pressure, 199 with diabetes and 63 with coronary artery disease.
About 109 participants, or 25%, had received a kidney transplant within the year before they developed COVID-19. More than half, 254 patients, stopped taking an immunosuppressive medication at diagnosis, according to the researchers.
Most cases occurred after Dec. 15, 2021, when omicron strains were circulating, Johns Hopkins said. The study reported 260 participants, or 60%, in that period; 145, or 34%, in the pre-delta period through July 1, 2021; and 27, or 6%, during the delta period from July 2 to Dec. 15, 2021.
Vaccination was also common in the study group. Johns Hopkins reported that 165 patients had received three or more COVID-19 vaccine doses and 89 had received one or two doses.
Why doctors may weigh the findings cautiously
Nitipong Permpalung, senior study author and associate director of the Johns Hopkins Transplant Research Center, said the results suggest prompt antiviral treatment may have benefits beyond the first stage of COVID-19 for kidney transplant recipients. He said clinicians consider immune function, kidney health, immunosuppressive therapy, possible drug interactions, side effects, and the timing and severity of infection when treating these patients.
The remdesivir group was older than the comparison group, with a median age of 61 versus 54, and more likely to need breathing support, 33% versus 11%, according to Johns Hopkins. Karan Srisurapanont, the first author, said early suppression of viral replication could plausibly reduce inflammation, blood vessel injury and clotting-related complications tied to heart and kidney problems.
This story draws on original reporting from Medical Xpress.