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

AbstractBackgroundConvalescent plasma therapy (CPT) and remdesivir (REM) have been approved for investigational use to treat coronavirus disease 2019 (COVID-19) in Nepal.MethodsIn 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.ResultsPatients 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.ConclusionsThis 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.