Contraindicated Remdesivir Use Among Individuals Hospitalized Due to COVID-19: According to the Danish Treatment Guidelines

OBJECTIVES: We aimed to evaluate whether remdesivir was administered to individuals who had a contraindication. In 2020, recommendations to use remdesivir was included in international and national COVID-19 treatment guidelines. In the Danish COVID-19 treatment guidelines, the stated contraindications are estimated glomerular filtration rate (eGFR) < 30 ml/minute, dialysis, plasma alanine aminotransferase (ALT) > 5 times above the upper limit of normal, hypersensitivity against remdesivir, multiorgan failure, and use of more than one vasopressor against septic shock. The stated relative contraindications (i.e. use with caution) are pregnancy and breast feeding.

METHODS: We included individuals aged ≥12 years who were hospitalized due to COVID-19 in the Capital Region of Denmark from 2020/06/04 to 2021/11/28. We excluded hospitalizations with a duration of less than four hours, individuals participating in a remdesivir trial, individuals with remdesivir initiation before admission and individuals with prior COVID-19 hospitalization. Biomarkers and treatment with vasopressors or dialysis were assessed in the time period between admission and remdesivir initiation. We used the biomarker measurement closest in time to (and before) remdesivir initiation. Hypersensitivity, multiorgan failure and breast feeding were unavailable.

RESULTS: In the Capital Region of Denmark, 5,534 individuals were hospitalized due to COVID-19, and 2,116 (38%) of these individuals were treated with remdesivir (hereafter denoted “remdesivir group”). In the remdesivir group, <3 individuals were on dialysis, <3 individuals had prior treatment with more than one vasopressor and 11 individuals (0.5%) were pregnant. The eGFR was <30 ml/minute for 19 individuals in the remdesivir group (0.9%) and missing for 245(11.6%) individuals. The ALT level was > 5 times above the upper limit of normal for 7 individuals in the remdesivir group (0.3%) and missing for 307(14.5%) individuals.

CONCLUSIONS: In the Capital Region of Denmark, remdesivir treatment in COVID-19 patients with a contraindication as defined by the Danish COVID-19 treatment guidelines was uncommon.