VEKLURY improved clinical outcomes in hospitalized patients with severe COVID-19 1-3
Study 5773 trial design
Study GS-US-540-5773 was a randomized, open-label, multicenter, phase 3 study in hospitalized adult patients with confirmed SARS-CoV-2 infection, an SpO2 of ≤94% on room air, or receiving supplemental oxygen and radiological evidence of pneumonia.
Treatment with VEKLURY® (remdesivir) was stopped in subjects who were discharged from the hospital prior to completion of their protocol-defined duration of treatment. Patients on mechanical ventilation at screening were excluded.
Primary endpoint: clinical status on Day 14 based on ordinal scale
Clinical status was assessed on a 7-point ordinal scale consisting of the following categories: 1. death; 2. hospitalized, receiving invasive mechanical ventilation or ECMO; 3. hospitalized, receiving noninvasive ventilation or high-flow oxygen devices; 4. hospitalized, requiring low-flow supplemental oxygen; 5. hospitalized, not requiring supplemental oxygen but receiving ongoing medical care (related or not related to COVID-19); 6. hospitalized, requiring neither supplemental oxygen nor ongoing medical care (other than that specified in the protocol for VEKLURY administration); 7. not hospitalized.
Baseline characteristics
| Characteristic | 5-Day group(n=200) | 10-Day group(n=197) |
|---|---|---|
| Median age | 61 (IQR, 50-69) | 62 (IQR, 50-71) |
| Male sex | 60% | 68% |
| Race | ||
| White | 71% | 70% |
| Black | 10% | 12% |
| Asian | 10% | 13% |
| Respiratory status | ||
| Low-flow oxygen | 56% | 54% |
| High-flow oxygen | 24% | 30% |
| Invasive mechanical ventilation/ECMO | 2% | 5% |
| Coexisting conditions of interest | ||
| Diabetes | 24% | 22% |
| Hyperlipidemia | 20% | 25% |
| Hypertension | 50% | 50% |
| Asthma | 14% | 11% |
5 days of treatment with VEKLURY led to similar clinical outcomes as a 10-day course
of patients saw clinical improvements of ≥2 points
(65% in the 5-day arm and 54% in the 10-day arm; odds ratio for improvement: 0.75 [95% CI, 0.51-1.12])*
*Once adjusted for between-group differences at baseline.
of patients experienced recovery†
(64% in the 5-day arm and 54% in the 10-day arm;
†Recovery was defined as those with a baseline ordinal score of 2 to 5 who improved to a score of 6 or 7.
7-point ordinal scale
Adverse reactions in Study 5773
The most common adverse reactions occurring in ≥5% of patients in either the VEKLURY 5-day or 10-day group, respectively, were nausea (5% vs 3%), AST increased (3% vs 6%), and ALT increased (2% vs 7%).
All-cause mortality at Day 28
- No statistically significant differences between the 2 groups
- 12% vs 14% in the 5- and 10-day treatment groups, respectively
Important Safety Information
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Contraindication
- VEKLURY is contraindicated in patients with a history of clinically significant hypersensitivity reactions to VEKLURY or any of its components.
Warnings and precautions
- Hypersensitivity, including infusion-related and anaphylactic reactions: Hypersensitivity, including infusion-related and anaphylactic reactions, has been observed during and following administration of VEKLURY. Monitor patients under close medical supervision for hypersensitivity reactions during and following administration of VEKLURY. Symptoms may include hypotension, hypertension, tachycardia, bradycardia, hypoxia, fever, dyspnea, wheezing, angioedema, rash, nausea, diaphoresis, and shivering. Slower infusion rates (maximum infusion time ≤120 minutes) can potentially prevent these reactions. If a severe infusion-related hypersensitivity reaction occurs, immediately discontinue VEKLURY and initiate appropriate treatment (see Contraindications).
- Increased risk of transaminase elevations: Transaminase elevations have been observed in healthy volunteers and in patients with COVID-19 who received VEKLURY; these elevations have also been reported as a clinical feature of COVID-19. Perform hepatic laboratory testing in all patients (see Dosage and administration). Consider discontinuing VEKLURY if ALT levels increase to >10x ULN. Discontinue VEKLURY if ALT elevation is accompanied by signs or symptoms of liver inflammation.
- Risk of reduced antiviral activity when coadministered with chloroquine or hydroxychloroquine: Coadministration of VEKLURY with chloroquine phosphate or hydroxychloroquine sulfate is not recommended based on data from cell culture experiments, demonstrating potential antagonism, which may lead to a decrease in the antiviral activity of VEKLURY.
Adverse reactions
- The most common adverse reaction (≥5% all grades) was nausea.
- The most common lab abnormalities (≥5% all grades) were increases in ALT and AST.
Drug interactions
- Drug interaction trials of VEKLURY and other concomitant medications have not been conducted in humans.
Dosage and administration
- Dosage: For adults and pediatric patients ≥12 years old and weighing ≥40 kg: 200 mg on Day 1, followed by once-daily maintenance doses of 100 mg from Day 2 administered only via intravenous infusion over 30 to 120 minutes.
- Treatment duration: For patients not requiring invasive mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO): 5 days; may be extended up to 5 additional days (10 days total) if clinical improvement is not observed. For patients requiring invasive mechanical ventilation and/or ECMO: 10 days.
- Testing prior to and during treatment: Perform eGFR, hepatic laboratory, and prothrombin time testing prior to initiating VEKLURY and during use as clinically appropriate.
- Renal impairment: VEKLURY is not recommended in individuals with eGFR <30 mL/min.
- Dose preparation and administration: See full Prescribing Information.
Pregnancy and lactation
- Pregnancy: There are insufficient human data on the use of VEKLURY during pregnancy. Pregnant women hospitalized with COVID-19 are at risk for serious morbidity and mortality. VEKLURY should be used during pregnancy only if the potential benefit justifies the potential risk for the mother and the fetus.
- Lactation: It is not known whether VEKLURY can pass into breast milk. Breastfeeding individuals with COVID-19 should follow practices according to clinical guidelines to avoid exposing the infant to COVID-19.
INDICATION
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For patients hospitalized with COVID-19: VEKLURY is indicated for treatment of adults and pediatric patients ≥12 years old and weighing ≥40 kg requiring hospitalization for COVID-19. VEKLURY is indicated for the treatment of adults and pediatric patients ≥12 years old and weighing ≥40 kg requiring hospitalization for COVID-19. VEKLURY should only be administered in a hospital or healthcare setting capable of providing acute care comparable to inpatient hospital care.
For information about emergency use to treat suspected or laboratory-confirmed COVID-19 in hospitalized pediatric patients weighing 3.5 kg to less than 40 kg or hospitalized pediatric patients less than 12 years of age weighing at least 3.5 kg, please see the EUA Fact Sheet and FDA Letter of Authorization available at gilead.com/remdesivir.
Please see full Prescribing Information for VEKLURY.
ALT=alanine aminotransferase; AST=aspartate aminotransferase; COVID-19=coronavirus disease 2019; ECMO=extracorporeal membrane oxygenation; IQR=interquartile range; SARS-CoV-2=severe acute respiratory syndrome coronavirus 2; SpO2=oxygen saturation.
References: 1. Veklury. Package insert. Gilead Sciences, Inc.; 2020. 2. Goldman JD, Lye DCB, Hui DS, et al. Remdesivir for 5 or 10 days in patients with severe Covid-19. N Engl J Med. 2020;383(19):1827-1837. 3. Goldman JD, Lye DCB, Hui DS, et al. Remdesivir for 5 or 10 days in patients with severe Covid-19. Supplement 1. Protocol. N Engl J Med. 2020;383(19):1827-1837. Accessed February 1, 2021. https://www.nejm.org/doi/suppl/10.1056/NEJMoa2015301/suppl_file/nejmoa2015301_protocol.pdf
View All
INDICATION
View All
Collapse
For patients hospitalized with COVID-19: VEKLURY is indicated for treatment of adults and pediatric patients ≥12 years old and weighing ≥40 kg requiring hospitalization for COVID-19. VEKLURY is indicated for the treatment of adults and pediatric patients ≥12 years old and weighing ≥40 kg requiring hospitalization for COVID-19. VEKLURY should only be administered in a hospital or healthcare setting capable of providing acute care comparable to inpatient hospital care.
For information about emergency use to treat suspected or laboratory-confirmed COVID-19 in hospitalized pediatric patients weighing 3.5 kg to less than 40 kg or hospitalized pediatric patients less than 12 years of age weighing at least 3.5 kg, please see the EUA Fact Sheet and FDA Letter of Authorization available at gilead.com/remdesivir.
Please see full Prescribing Information for VEKLURY.
Important Safety Information
Collapse
Contraindication
- VEKLURY is contraindicated in patients with a history of clinically significant hypersensitivity reactions to VEKLURY or any of its components.
Warnings and precautions
- Hypersensitivity, including infusion-related and anaphylactic reactions: Hypersensitivity, including infusion-related and anaphylactic reactions, has been observed during and following administration of VEKLURY. Monitor patients under close medical supervision for hypersensitivity reactions during and following administration of VEKLURY. Symptoms may include hypotension, hypertension, tachycardia, bradycardia, hypoxia, fever, dyspnea, wheezing, angioedema, rash, nausea, diaphoresis, and shivering. Slower infusion rates (maximum infusion time ≤120 minutes) can potentially prevent these reactions. If a severe infusion-related hypersensitivity reaction occurs, immediately discontinue VEKLURY and initiate appropriate treatment (see Contraindications).
- Increased risk of transaminase elevations: Transaminase elevations have been observed in healthy volunteers and in patients with COVID-19 who received VEKLURY; these elevations have also been reported as a clinical feature of COVID-19. Perform hepatic laboratory testing in all patients (see Dosage and administration). Consider discontinuing VEKLURY if ALT levels increase to >10x ULN. Discontinue VEKLURY if ALT elevation is accompanied by signs or symptoms of liver inflammation.
- Risk of reduced antiviral activity when coadministered with chloroquine or hydroxychloroquine: Coadministration of VEKLURY with chloroquine phosphate or hydroxychloroquine sulfate is not recommended based on data from cell culture experiments, demonstrating potential antagonism, which may lead to a decrease in the antiviral activity of VEKLURY.
Adverse reactions
- The most common adverse reaction (≥5% all grades) was nausea.
- The most common lab abnormalities (≥5% all grades) were increases in ALT and AST.
Drug interactions
- Drug interaction trials of VEKLURY and other concomitant medications have not been conducted in humans.
Dosage and administration
- Dosage: For adults and pediatric patients ≥12 years old and weighing ≥40 kg: 200 mg on Day 1, followed by once-daily maintenance doses of 100 mg from Day 2 administered only via intravenous infusion over 30 to 120 minutes.
- Treatment duration: For patients not requiring invasive mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO): 5 days; may be extended up to 5 additional days (10 days total) if clinical improvement is not observed. For patients requiring invasive mechanical ventilation and/or ECMO: 10 days.
- Testing prior to and during treatment: Perform eGFR, hepatic laboratory, and prothrombin time testing prior to initiating VEKLURY and during use as clinically appropriate.
- Renal impairment: VEKLURY is not recommended in individuals with eGFR <30 mL/min.
- Dose preparation and administration: See full Prescribing Information.
Pregnancy and lactation
- Pregnancy: There are insufficient human data on the use of VEKLURY during pregnancy. Pregnant women hospitalized with COVID-19 are at risk for serious morbidity and mortality. VEKLURY should be used during pregnancy only if the potential benefit justifies the potential risk for the mother and the fetus.
- Lactation: It is not known whether VEKLURY can pass into breast milk. Breastfeeding individuals with COVID-19 should follow practices according to clinical guidelines to avoid exposing the infant to COVID-19.
