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.