Remdesivir in COVID-19- new Cure or Illusion

Remdesivir (also GS-5734) is a monophosphoramidate prodrug of an adenosine analogue that has a broad antiviral spectrum including filoviruses, paramyxoviruses, pneumoviruses, and coronaviruses. In vitro, remdesivir inhibits all human and animal coronaviruses tested to date, including SARS-CoV-2.

 Intravenous remdesivir was studied for treatment of Ebola virus disease, in which it was adequately tolerated but less effective than several monoclonal antibody therapeutics,and has been used on the basis of individual compassionate use over the past several months in patients with COVID-19 in some countries.

Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial

Strengths –

Only RCT on this topic

Limitations-

•6 days difference; assuming 21 days with placebo. HR( expected- 1.43); HR (observed) – 1.23

•453 patients: 302: 151 ( randomisation 2:1 ) ???

•Terminated on March 12 with 237 patients due to effective lockdown measures; power was 58%

•Late treatment initiation

•Combination with other drugs, including steroids

•Dose, duration of treatment- uncertain

Conclusion –

Inconclusive evidence in support of Remdesivir.

Can be used in research context but its too early to call it as a CURE for COVID-19.