Risk assessment
A risk score can aid clinical judgement on treatment with remdesivir. Patients with a low 4C Mortality Score (0-3) are highly likely to recover without remdesivir treatment.
If clinical judgement determines the patient is unlikely to survive on presentation to hospital, do not initiate remdesivir. The 4C Mortality Score may be helpful in such cases. (See appendix 2 and calculation in the common admission document on the MORSE system)
Initiation of treatment
The decision to initiate treatment with remdesivir should be made by the admitting consultant
Review and stopping criteria
- Consider stopping if there is clinical improvement and supplemental oxygen is no longer required 72 hours after starting treatment.
- Consider stopping if the patient deteriorates despite 48 hours of sustained mechanical ventilation.
- Stop if ALT rises to 5 times the upper limit of normal or more during therapy with remdesivir (can restart if ALT falls below this threshold).
- Stop if ALT elevation is accompanied by signs or symptoms of liver inflammation or increasing conjugated bilirubin, alkaline phosphatise or INR
- Stop if eGFR falls below 30ml/min (except in end stage renal disease on haemodialysis)
Immunocompromised patients
The time between symptom onset and treatment starting does not apply
The need for supplemental oxygen does not apply
Definition of patient group: patients with a significant impairment of humoral immune response (antibody production) and/or cellular immune competence.
Pregnancy
Remdesivir should be avoided in pregnancy unless clinicians believe the benefits of treatment outweigh the risks to the individual. There are no or limited data from the use of remdesivir in pregnant women. Women of child-bearing potential have to use effective contraception during treatment.
4C Mortality Score