Remdesivir 於腎功能不全患者的使用

A Brief Discussion on the Use of Remdesivir in Patients with Renal Impairment

新型冠狀病毒肺炎（coronavirus disease 2019，COVID-19；簡稱新冠肺炎）三年來在全世界造成大規模的傳染及死亡，而remdesivir是治療新冠肺炎重症的重要藥物。腎功能不全族群，包括透析患者、第四期和第五期的慢性腎臟病患者、急性腎損傷患者或是換腎患者，均為得到新冠肺炎後死亡的高風險族群。然而，因ACTT-1臨床試驗中排除了腎絲球過濾率估算值小於30/mL/min/1.73m2的患者，以致於嚴重腎功能不全者在remdesivir的仿單中被列為不建議使用的族群。本綜論藉由文獻回顧後發現，以remdesivir治療嚴重腎功能不全的新冠肺炎患者，肝腎損傷風險並沒有顯著增加，耐受度良好，且可能有臨床上的效益。考量腎功能不全者的高死亡風險和使用remdesivir的高耐受度，臨床醫師在權衡利弊和善盡告知義務後，可用醫病共享決策的方式討論是否給予remdesivir來治療嚴重腎功能不全患者的重症新冠肺炎。

The coronavirus disease (COVID-19) has caused large-scale disease burden and deaths worldwide for 3 years. Remdesivir is an important drug for treating patients with severe COVID-19. Patients with renal dysfunction, including dialysis, stage 4 and 5 chronic kidney disease, acute kidney injury, and kidney transplant patients, have a high mortality risk after contracting COVID-19. However, because patients with estimated glomerular filtration rates less than 30 mL/min/1.73 m2 were excluded from the ACTT-1 clinical trial, patients with severely impaired renal function are not recommended to receive remdesivir. In this review, we found that the use of remdesivir to treat COVID-19 patients with severe renal function impairment did not significantly increase the risk of liver toxicity or kidney injury and showed good tolerability with potential clinical benefits. Considering the high mortality risk in patients with renal impairment and high tolerability of remdesivir, clinicians can apply shared decision-making to discuss whether to use remdesivir to treat patients with severe renal function impairment and severe COVID-19 after balancing the advantages and disadvantages and fulfilling the duty to inform patients.