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Hemoadsorption eliminates remdesivir from the circulation: Implications for the treatment of COVID-19

Paul Biever1,2,3, Dawid L Staudacher1,2, Michaela J Sommer4,5

  • 1Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Pharmacology Research & Perspectives
|March 12, 2021
PubMed

Insights

The CytoSorb device significantly removes remdesivir and its active metabolite GS-441524 from blood in vitro. Simultaneous use of remdesivir and CytoSorb therapy in severe COVID-19 patients is not recommended due to drug elimination.

Area of Science:

  • Pharmacology
  • Critical Care Medicine
  • Biomedical Engineering

Background:

  • Severe COVID-19 treatment involves antiviral remdesivir and hemoadsorption with CytoSorb.
  • CytoSorb adsorbs various molecules, including cytokines and drugs.
  • Potential drug-device interactions require investigation.

Purpose of the Study:

  • To evaluate the adsorption of remdesivir and its metabolite GS-441524 by the CytoSorb device in vitro.
  • To determine the impact of CytoSorb on remdesivir and GS-441524 concentrations.

Main Methods:

  • Serum containing remdesivir or GS-441524 was circulated through a CytoSorb device in a custom system.
  • Drug concentrations were analyzed using liquid chromatography-tandem mass spectrometry.
  • Pre- and post-adsorber concentrations were measured to assess removal efficiency.

Main Results:

  • CytoSorb rapidly and almost completely removed remdesivir from the perfusate within 60 minutes.
  • GS-441524 showed similar rapid elimination, reaching an adsorption-desorption equilibrium around 48 µg/L.
  • Both remdesivir and GS-441524 were significantly reduced by the CytoSorb device in vitro.

Conclusions:

  • Remdesivir and its active metabolite GS-441524 are effectively eliminated by the CytoSorb adsorber.
  • Concurrent use of remdesivir and CytoSorb in patients should be avoided.
  • Close monitoring of therapeutic drug plasma levels during CytoSorb therapy is crucial.

Keywords:
COVID-19SARS-CoV-2cytokinehemoadsorptionremdesivir

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