Remdesivir was first identified as an investigational drug to treat Ebola virus disease during the West African outbreak in 2013–2016. Given the mechanism of action of remdesivir as an antiviral that halts viral replication, these trial findings support the use of remdesivir in the early active viral replication phase in the COVID-19 polymerase chain reaction-positive patients.
If patients progress from the viral replication phase to the inflammatory phase of infection, such as patients with acute respiratory distress syndrome requiring ventilation, remdesivir is not effective and anti-inflammatory drugs may be beneficial.
Remdesivir has emerged as one of the initial drugs for the use against SARS CoV-2 infection and is touted as the “molecule of hope.” The initial data showed a decrease in the duration of illness and proven safety profile lead to its rapid approval for emergency use by the US Food and Drug Administration.
The interim results in the Solidarity trial in the investigational drug arms led to major confusion as to whether to use the drug or not as there to be seemed no mortality benefit as well reduction in the need for ventilation. The various other trials showed a decrease in hospital stay and or reduction in the illness, which is a major benefit. The safety profile of the drug and the reduction in duration of illness would benefit by leading to a reduction in load on the already strained healthcare system, as has been highlighted by the article on “Placing the results of the SOLIDARITY trial with regards to remdesivir in perspective.”
At present, remdesivir remains an investigational drug for the treatment of COVID-19. Although it is associated with shorter hospital length of stay and a more rapid clinical convalescence, no mortality benefit has been demonstrated. These results do not provide clear evidence on the efficacy and safety of remdesivir against COVID-19. It has been suggested that remdesivir is unlikely to achieve adequate concentration in lung tissues through intravenous infusion alone because of its low tissue distribution and poor lung penetration.
A proposed combination of pulmonary and intravenous administration of remdesivir has been suggested for a more effective strategy for the treatment of COVID-19. We have to agree that the establishment of the role of remdesivir across the disease spectrum of COVID-19 requires more studies comparing different treatment strategies and/or routes of administration like a combination of antiviral therapy with immune-modulatory agents, particularly in severe COVID-19 disease, are needed.
At present, the only hope we have is in the form of this drug and we should use it at the right time and in the right population for the desired results till the time we get a magic bullet to target our opponent.
As someone has said “Be strong now because things will get better. It may be stormy now but it can’t rain forever.
Dr P Harsha Vardhana Varma Penumatsa
Qualification : MBBS,M.D
Specialty : Chest Physician