Background & aims: Remdesivir is a broad spectrum anti-viral drug that has shown to inhibit SARS-CoV-2, in vitro and in vivo. In absence of any effective treatment for SARS-CoV-2 infection (COVID-19), remdesivir has been tried for a compassionate use in severe COVID-19. Newer randomized controlled studies that have recently become available, showed a mixed result. We aimed to systematically search the literature to understand the pharmacology and clinical effects of remdesivir in patients with COVID-19.
Methods: We systematically searched the PubMed, ClinicalTrial.Org and MedRxiv database up till May 5, 2020 using specific key words such as "Remdesivir" or 'GS-5734″ AND "COVID-19" or "SARS-CoV-2" and retrieved all the article published in English language, that have reported the pharmacology and the clinical outcomes of remdesivir in patients with COVID-19.
Results: Initial compassionate use of remdesivir has shown a fairly good result, but difficult to quantify, in the absence of control arm. While the very first double-blind, placebo-controlled, randomized trial conducted in Wuhan, did not find any significant benefit compared to the control, the preliminary result of another similar multi-country trial has shown a significant faster time to recovery but without any difference in mortality.
Conclusions: Remdesivir has shown a mixed result in patients with COVID-19 with an acceptable side effect. However, jury is still out while awaiting the results from the forthcoming trials.
Keywords: COVID-19; Clinical outcome; Mortality; Remdesivir; SARS-Co-V-2.
Copyright © 2020 Diabetes India. Published by Elsevier Ltd. All rights reserved.
Conflict of interest statement
Declaration of competing interest Nothing to declare by all the authors.
Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial.Lancet. 2020 May 16;395(10236):1569-1578. doi: 10.1016/S0140-6736(20)31022-9. Epub 2020 Apr 29. Lancet. 2020. PMID: 32423584 Free PMC article. Clinical Trial.
Remdesivir: Review of pharmacology, pre-clinical data and emerging clinical experience for COVID-19.Pharmacotherapy. 2020 May 23. doi: 10.1002/phar.2429. Online ahead of print. Pharmacotherapy. 2020. PMID: 32446287 Review.
Remdesivir for Treatment of COVID-19: Combination of Pulmonary and IV Administration May Offer Aditional Benefit.AAPS J. 2020 May 26;22(4):77. doi: 10.1208/s12248-020-00459-8. AAPS J. 2020. PMID: 32458279 Free PMC article.
Compassionate Use of Remdesivir for Patients with Severe Covid-19.N Engl J Med. 2020 Apr 10:NEJMoa2007016. doi: 10.1056/NEJMoa2007016. Online ahead of print. N Engl J Med. 2020. PMID: 32275812 Free PMC article.
Current knowledge about the antivirals remdesivir (GS-5734) and GS-441524 as therapeutic options for coronaviruses.Version 2. One Health. 2020 Mar 27;9:100128. doi: 10.1016/j.onehlt.2020.100128. eCollection 2020 Jun. One Health. 2020. PMID: 32258351 Free PMC article. Review.
- Sheahan T.P., Sims A.C., Graham R.L. Broad-spectrum antiviral GS-5734 inhibits both epidemic and zoonotic coronaviruses. Sci Transl Med. 2017;9
- Agostini M.L., Andres E.L., Sims A.C., Graham R.L., Sheahan T.P., Lu X. Coronavirus susceptibility to the antiviral remdesivir (GS-5734) is mediated by the viral polymerase and the proofreading exoribonuclease. mBio. 2018;9 doi: 10.1128/mBio.00221-18. - DOI
- Summary on compassionate use remdesivir Gilead. https://www.ema.europa.eu/en/documents/other/summary-compassionate-use-remdesivir-gilead_en.pdf (Accessed May 5, 2020)
- Mulangu S., Dodd L.E., Davey R.T., Jr. A randomized, controlled trial of Ebola virus disease therapeutics. N Engl J Med. 2019;381:2293–2303. - PubMed