Experience of Treating COVID-19 With Remdesivir and Convalescent Plasma in a Resource-Limited Setting: A Prospective, Observational Study
Authors: Koirala Janak , Gyanwali Pradip , Gerzoff Robert B , Bhattarai Saroj , Nepal Bipin , Manandhar Rekha , Jha Runa , Sharma Sanjib , Sharma Yuba Raj , Bastola Anup , Murphy Holly , Acharya Subhash , Adhikari Prabhat , Rajkarnikari Manita , Vaidya Karishma M , Panthi Chhabi L , Bista Bihungum , Giri Grishma , Aryal Shambhu , Pant Suman , Pokharel Akritee , Karki Shristi , Basnet Sangita , Koirala Bhagawan , Dhimal Meghnath ,   Nepal COVID-19 Clinical Study Collaborators, Jha Roshan Kumar , Shrestha Anil , Dhungana Ashesh , Shrestha Shreejana , Pandey Sarita , Shakya Sangita , Ranjit Philip S , Dhungel Sunil , Bhattarai Devendra , Gautam Sumitra , Poudel Pramod , Sapkota Kalyan , Shah Khagendra J , Mandal Rajesh K , Pandey Rajan , Prajapati Sumit , Hussain Arif , Gupta Shakuntala , Chhetri Roshan , Pokharel Krishna , Thapa Kala , Adhikari Shital , Deo Gopendra P , Gauli Basanta , Ghimire Pukar , Regmi Bishnu , Gurung Ram B , Shrestha Rajeev , Tamrakar Dipesh , Khanal Sushil , Acharya Upasana , Sapkota Suhail , Shrestha Reema , Sijapati Milesh J , Koirala Smriti , Bajracharya Suraj , Sigdel Deepak , Acharya Den P , Chhetri Sudarshan , Acharya Prashanta , Panthi Hari P , Dhungana Ashesh , Karki Achyut R , Singh Ram K , Singh Uday N , Tiwari Rakesh , Hussain Asraf , Shah Rupesh , Ansari Parwez A , Aryal Diptesh , Shrestha Sanjit K , Koirala Kanchan , Kumar KC Kiran , Acharya Bidur P , BK Shyam , Pandey Sumit , Gupta Suraj K , Shakya Deepa , Sapkota Yunima , Adhikari Anju , Koirala Bishwanath , Karki Bipin , Sharma Yuba R , Pandey Bimal K , Lamichhane Buddhi S , Shrestha Sanjay , Kamar Sher B , Chaudhary Ashok , Joshi Jagdish , Sherpa Kunjang , Manandhar Reeju , Pant Chiranjibi , Joshi Rinku , Bastola Anup , Chalise Bimal S , Das Santa K , Shrestha Pramesh S 
Published: August 2021

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 &lt;5% of patients.

Conclusions

This study demonstrates a safe rollout of CPT and REM in a resource-limited setting. Remdesivir recipients had less severe infection and better outcomes.

ClinicalTrials.gov identifier. NCT04570982.