key: cord-0745016-75u0su20 authors: Cubeddu, Luigi X.; Cubeddu, Robert J. title: Early remdesivir treatment in COVID‐19: Why wait another day? date: 2021-02-01 journal: J Med Virol DOI: 10.1002/jmv.26792 sha: 5347dffae558d7bd34cbd812956b8baef1ae31ba doc_id: 745016 cord_uid: 75u0su20 nan Coronavirus disease 2019 (COVID-19) is a viral respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that varies from asymptomatic to severe illness and death. 1, 2 Old age, hypertension, obesity, diabetes, cardiovascular disease, chronic lung disease, and cancer predict a severe course, risk of hospitalization, and death. 1, 2 The US Food and Drug Administration recently approved remdesivir for the treatment of COVID-19 patients requiring hospitalization. 3 However, high mortality persists despite use of remdesivir. 3, 4 Remdesivir inhibits SARS-CoV-2 RNA polymerase, hindering viral replication. 5 In patients with COVID-19, peak SARS-CoV-2 concentrations occur on Day 5 and most active replication in the throat during the first 5 days of symptoms onset. 6 In rhesus macaques infected with SARS-CoV-2 and Middle East respiratory syndrome coronavirus, best outcomes were obtained when remdesivir was started early, at 12 h of inoculation. 7, 8 These observations suggest that inhibiting viral replication with remdesivir would be more effective if started early after symptoms development. We here report our experience using an early treatment strategy in a high-risk patient with COVID-19 who within 48 h of symptoms onset received remdesivir and experienced an immediate and remarkable clinical response to full recovery. Table 1 ). The chest x-ray and 12-lead electrocardiogram were reportedly normal. Because of the age and clinical risk factors, the patient was admitted for further observation and management. The first dose of remdesivir 200 mg was administered at approximately 8 p.m., 48-h after symptom onset, followed by a daily intravenous dose of 100 mg for three additional days (Table 1 ). In addition, he received 40 mg of enoxaparin, losartan 50 mg daily, and benzonate as needed. By the second dose of remdesivir (24-h later), the symptoms had markedly The authors declare that there are no conflict of interests. All authors materially participated in the research, data collection and article preparation. Luigi X. Cubeddu and Robert J. Cubeddu approved the final article. Written informed consent was obtained from the patient for publication of this case report and accompanying table. T A B L E 1 Time and dose of remdesivir administration and laboratory values before, during and after hospitalization in a patient who tested positive for COVID-19 on 10/23/2020 Anion Gap (mmol/L) 12 9 8 10 9 Troponin T (ng/ml) <0.01 Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; COVID-19, coronavirus disease 2019; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; PCR, polymerase chain reaction; RDW, red cell distribution width; WBC, white blood cell. Factors associated with COVID-19-related death using OpenSAFELY COVID-19-associated hospitalization surveillance network Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial Remdesivir for the treatment of Covid-19 -final report Remdesivir is a direct-acting antiviral that inhibits RNA-dependent RNA polymerase from severe acute respiratory syndrome coronavirus 2 with high potency Virological assessment of hospitalized patients with COVID-2019 Clinical benefit of remdesivir in rhesus macaques infected with SARS-CoV-2 Prophylactic and therapeutic remdesivir (GS-5734) treatment in the rhesus macaque model of MERS-CoV infection Early administration of oral oseltamivir increases the benefits of influenza treatment DFA approves first treatment for COVID-19