COVID Study Supports Antiviral Use in Kidney Transplant Recipients
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Add MedPage Today on Google MedpageToday Key Takeaways Kidney transplant recipients face severe COVID-19 risks but often are excluded from key antiviral trials. In a target trial emulation, starting remdesivir (Veklury) soon after a COVID diagnosis was associated with a 47% lower risk of graft failure or death at 1 year. Early remdesivir also was associated with a 42% lower risk of cardiovascular events. Kidney transplant recipients with COVID-19 who received remdesivir (Veklury) early had a lower risk of graft loss, a target trial emulation study found.
Adding to this, Compared with no remdesivir, initiation of the antiviral within 7 days of a COVID diagnosis was associated with a 47% lower risk of graft failure or death at 1 year in an analysis that employed clone-censor-weight adjustment (HR 0.53, 95% CI 0.31-0.92), reported Nitipong Permpalung, MD, MPH, of Johns Hopkins University School of Medicine in Baltimore, and colleagues.
Meanwhile, This association was generally consistent across clinically relevant subgroups, according to the findings in JAMA Network Open , and early remdesivir was also associated with a 42% lower risk of cardiovascular events (HR 0.58, 95% CI 0.35-0.98).
Notably, "The main message for clinicians is to act early," Permpalung told MedPage Today . "When a kidney transplant recipient develops COVID-19 symptoms or tests positive, the patient should contact the transplant team promptly, and antiviral treatment should be considered before the illness becomes severe."
As per the latest buzz, Remdesivir is an important option particularly when an oral antiviral is not clinically suitable, he added. "However, our findings do not mean that every kidney transplant recipient should automatically receive remdesivir," Permpalung cautioned. "Treatment should be individualized based on the timing of infection, the patient's clinical risk, drug interactions, safety, preferences, and access to treatment."
In further updates, Kidney transplant recipients have a high risk of severe COVID-19 due to chronic immunosuppression, impaired vaccine responses, and comorbidities. "Mortality in hospitalized kidney transplant recipients during the early pandemic ranged from 20% to 32%, declining to 1% to 4% during the Omicron wave, likely due to vaccination, prior infection, and improved treatment," the researchers wrote.
On top of that, "Prevention and treatment should be viewed as complementary," Permpalung emphasized. " Vaccination remains the first layer of protection , but kidney transplant recipients may still have breakthrough infections because of their immunosuppression. When infection occurs, there should already be a plan for rapid testing, contacting the transplant team, and accessing antiviral treatment."
Although CDC guidelines recommend early antiviral therapy for patients at high risk of COVID-19 progression, many supporting trials excluded patients with severe kidney impairment and transplant recipients.
Source: MedPage Today