The journey of remdesivir: from Ebola to COVID-19

"Background

... In this narrative review, we will summarize the studies available to date for remdesivir in the context of viral outbreaks, especially its development as an antiviral agent for Ebola and coronaviruses...

Antiviral activity

Remdesivir exhibits broad in vitro antiviral action against zoonotic and human pathogens from multiple virus families... Among HCoV [human coronaviruses], remdesivir inhibits three of the endemic strains associated with respiratory illness (HCoV-OC43, 229E, and NL63) as well as the less common MERS-CoV, SARS-CoV, and novel SARS-CoV-2...

Clinical efficacy

... One of the first randomized, placebo-controlled, double-blind study in severe COVID-19 was released at the time of manuscript preparation. Wang and colleagues randomized hospitalized patients with severe COVID-19 in a 2:1 allocation to remdesivir (n=158) to matching placebo (n=78)... In the efficacy analysis, time to clinical improvement was similar between groups (median 21 days in the remdesivir group versus 23 days with placebo; hazard ratio [HR]: 1.23 [95% confidence interval (CI): 0.87–1.75]). Mortality at 28 days was also similar between groups (22 [14%] died in the remdesivir group versus 10 [13%] with placebo). SARS-CoV-2 RNA loads were not reduced with remdesivir compared to placebo...

Safety profile

... In the open-label COVID-19 compassionate use cohort, 32/53 (60%) patients reported adverse events, while 4/53 (8%) experienced adverse events leading to discontinuation... Adverse events leading to drug discontinuation occurred in 18 (12%) remdesivir patients and 4 (5%) placebo patients.

Conclusion

... Remdesivir has potent in vitro activity against EBOV [Ebola Virus], and was highly efficacious in an animal model of EVD [Ebola virus disease]. Unfortunately, early hopes for a new paradigm in EVD management were deflated with the completion of the first randomized trial."