Aya Allam, M.D., Steven Lippmann, M.D.

Early in the pandemic, then President Trump contracted a COVID-19 illness and took some medications to counter his illness. He survived. One of the drugs he received was remdesivir, an antiviral pharmaceutical. Now, more recently approved to counter coronavirus infections; what is there to know about remdesivir?

Further back, during the Ebola epidemic research began with antiviral drugs aiming to diminish viral RNA replication in human cells via inhibiting RNA-dependent polymerases. One of those pharmaceuticals was remdesivir; despite high hopes, efficacy was clinically weak.

Remdesivir is a pro-drug that activates in the body. Its antiviral properties derive from creating errors at the adenosine sequence in viral RNA, thus therapeutically blocking virus replication. This can diminish SARS-CoV-2 virus replication and might promote host health. Ideally, it reduces viral loads and pulmonary tissue injury, shortening the course of COVID-19 illness.

Remdesivir comes under the name, Veklury. Manufactured in preparations that must be reconstituted in a liquid that is slowly administered intravenously while supervised in a healthcare facility. Eligibility includes infected people being at least 12 years old and 88 pounds in weight, only early in the course of illness. It is not for hospitalized sick patients or for those receiving therapeutic oxygen. It is administered daily over five-to-ten days, based on clinical response. Side effects can encompass gastrointestinal, pulmonary, hepatic, and/or hematologic adversities; these require laboratory monitoring before and during this process.

Intended to combat SARS-CoV-2, clinical utility is less optimistic. However, it might speed recovery, diminish illness severity, but seems less good at mitigating mortality. These concerns, parenteral delivery, and significant cost have attenuated its prescribing. Research about remdesivir and other antiviral drugs is ongoing. Encouraging is that some of these newer versions are taken orally.

Full vaccination with a booster dose remains the most promising COVID-19 protection measure. There are also monoclonal antibody medicines becoming available. They offer laboratory-manufactured antibodies designed to block virus cell entry. In the short term, they act somewhat like natural and/or vaccine induced immunities, temporarily limiting cell invasion by viruses. In hopes for enhanced efficacy and because of different modes of action, antiviral drugs, like remdesivir, can safety be prescribed at the same time as monoclonal antibody therapies.

Delta variants of the SARS-CoV-2 recently have been common at causing most of the COVID-19 disease and is the third highest cause of death in the U.S.A. Omicron has just now become the predominant cause of contagion and coronavirus illness in this country and many other places throughout the world. Good luck to us all!