Early Remdesivir to prevent severe COVID-19 in solid organ transplant recipients: a real-life study from Northern Italy

OBJECTIVES: The effectiveness of 3-days course remdesivir to prevent severe disease in COVID-19 solid organ transplant (SOT) recipients is unknown. We wanted to study the efficacy of this therapeutic option in COVID-19 SOT recipients in preventing both hospitalisations, if outpatients, and clinical worsening due to COVID-19, if already hospitalised for other reasons. METHODS: This is a single-centre, retrospective, observational study conducted in the Fondazione IRCSS Policlinico San Matteo of Pavia, Northern Italy. We extracted all the data of COVID-19 SOT recipients who received and did not receive pre-emptive remdesivir between 23 December 2021 and 26 February 2022. We used a Cox proportional hazard model to assess whether receiving pre-emptive remdesivir was associated with lower rates of hospitalisation. RESULTS: Twenty-four SOT patients were identified. Among these, seven patients (29,1%) received pre-emptive remdesivir, whereas 17 (70,9%) patients did not. Receiving remdesivir significantly reduced the hospitalisation rate in SOT outpatients and the clinical worsening of already hospitalised SOT patients (HR 0.05; CI [0.00-0.65] p = 0.01). CONCLUSION: In our cohort of SARS-CoV-2 infected SOT recipients, pre-emptive remdesivir was effective in reducing the hospitalisation rate due to COVID-19 and in preventing the clinical worsening of the SOT patients hospitalized for reasons other than COVID-19