Remdesivir in COVID-19: A critical review of pharmacology, pre-clinical and clinical studies

Diabetes Metab Syndr. 2020 Jul-Aug;14(4):641-648. doi: 10.1016/j.dsx.2020.05.018. Epub 2020 May 12.

Abstract

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.

Publication types

  • Review

MeSH terms

  • Adenosine Monophosphate / analogs & derivatives*
  • Adenosine Monophosphate / pharmacology
  • Adenosine Monophosphate / therapeutic use
  • Alanine / analogs & derivatives*
  • Alanine / pharmacology
  • Alanine / therapeutic use
  • Antiviral Agents / pharmacology*
  • Antiviral Agents / therapeutic use*
  • Betacoronavirus / drug effects*
  • COVID-19
  • COVID-19 Drug Treatment
  • Coronavirus Infections / drug therapy*
  • Drug Evaluation, Preclinical
  • Humans
  • Pandemics
  • Pneumonia, Viral / drug therapy*
  • Randomized Controlled Trials as Topic
  • SARS-CoV-2
  • Treatment Outcome

Substances

  • Antiviral Agents
  • remdesivir
  • Adenosine Monophosphate
  • Alanine