That Escalated Quickly: Remdesivir's Place in Therapy for COVID-19
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REVIEW
That Escalated Quickly: Remdesivir’s Place in Therapy for COVID-19 Matthew R. Davis
. Erin K. McCreary . Jason M. Pogue
Received: June 9, 2020 Ó The Author(s) 2020
ABSTRACT Key Summary Points Remdesivir is a nucleoside antiviral recently studied in several randomized trials for treatment of COVID-19. The available observational and prospective data are conflicting, requiring clinicians to critically evaluate and reconcile results to determine patient populations that may optimally benefit from remdesivir therapy, especially while drug supply is scarce. In this review, we analyze pertinent clinical remdesivir data for patients with COVID-19 from January 1, 2020, through May 31, 2020.
Keywords: ACTT-1; Antiviral; Coronavirus disease 2019; COVID-19; Remdesivir; SARSCoV-2
Results have been mixed for remdesivir in studies of COVID-19, but it is the first effective therapy for COVID-19 regarding shortening time to recovery. Limited availability of remdesivir requires clinicians to face difficult decisions when prioritizing patients. This report summarizes and aggregates the available clinical data to aid in clinical decision-making for remdesivir therapy. Remdesivir is generally well tolerated with comparable rates of adverse events to placebo.
Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12563738. M. R. Davis (&) Department of Clinical Pharmacy, University of California Los Angeles Ronald Reagan Medical Center, Los Angeles, CA, USA e-mail: [email protected] E. K. McCreary Division of Infectious Diseases, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA J. M. Pogue Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
BACKGROUND Remdesivir is a nucleoside analog prodrug with potent in vitro activity against numerous human and zoonotic coronaviruses; it has also demonstrated clinical benefit in animal models of SARS-CoV, MERS-CoV, and SARS-CoV-2 infection [1–11]. Antiviral activity is mediated by preferential incorporation of the molecule by viral RNA-dependent RNA polymerase into the
Infect Dis Ther
RNA transcript, leading to delayed chain termination due to steric impedance [12, 13]. For a detailed discussion of pre-clinical, pharmacology, and pharmacokinetic data, the reader is directed to a recent review by Jorgensen et al. [9]. Since the publication of this review, results from two randomized trials evaluating remdesivir for hospitalized patients with COVID-19 were published. Herein, we aim to aid clinicians in delineating the role of remdesivir for treatment of COVID-19 by critically analyzing and aggregating available, pertinent clinical data from January 1, 2020, to May 31, 2020. Patients represented by these data received remdesivir via a compassionate use pathway or enrollment in a clinical trial. Currently, there is no FDAapproved medication for the treatment of COVID-19. This article is based on previously conducted studies and does not contain any studie
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