Role of remdesivir for the treatment of COVID‐19 in patients with hematologic malignancy—A narrative review and expert opinion

Background COVID‐19 remains a potentially severe condition for immunocompromised individuals, such as patients with hematologic malignancy. These patients are at increased risk of progressing to severe–critical or prolonged COVID‐19. Prompt treatment with antivirals has proven effective in preventing disease progression and is recommended by current guidelines. We discuss here the position of remdesivir in the management of onco‐hematologic patients infected with SARS‐CoV‐2 and strategies for its use. Methods Narrative review of current evidence regarding remdesivir in the treatment of COVID‐19 in patients with hematologic malignancy. Results Patients with non‐severe COVID‐19 should receive remdesivir as soon as possible after diagnosis, and within 7 days from symptom onset. A 3‐day treatment duration is recommended. In patients at high risk of developing severe COVID‐19 – patients with B‐cell depletion and recipients of allogeneic HSCT or CAR T cell therapy or bispecific antibodies – treatment may be prolonged and/or combined with other COVID‐19 therapeutics. Patients with severe COVID‐19 requiring supplemental oxygen should receive remdesivir as soon as possible, preferentially for 10 days. In those at high risk of progressing to critical COVID‐19, combination of remdesivir with other COVID‐19 therapeutics can be considered. In case of relapse or persisting symptoms, remdesivir treatment can be prolonged and/or repeated or combined with other COVID‐19 therapeutics. Conclusions Evidence from clinical trials and real‐world studies shows that remdesivir is a valid option for the treatment of SARS‐CoV‐2‐infected onco‐hematologic patients, across a wide spectrum of COVID‐19 severity. The drawback of remdesivir—intravenous administration mode—is counterbalanced by good tolerability, negligible drug–drug interactions and a high barrier to virus resistance.