Medicines

Remdesivir uses in covid-19. Does it really work?

Remdesivir uses Posted On
Posted By SUMIT SHARMA

Today, coronavirus disease-19 (COVID 19) has become a critical issue for the world. The second wave of this virus is being devastating across the country. During this pandemic, remdesivir injection demand is increasing day by day. That’s why today, I am going to talk about remdesivir uses in the treatment of COVID-19 with scientific evidence. 

Well! There are currently no proven antiviral medicines in the treatment of coronavirus infection. However, Remdesivir was found some efficacy to decrease coronavirus burden, but it is not a primary treatment. 

In this article, I will discuss remdesivir uses, its mechanism, efficacy, and safety. 

Let’s start the topic. 

 

What is Remdesivir used for?

Remdesivir is a broad-spectrum antiviral drug, and this drug is invented by Gilead Sciences, a biopharmaceutical company. 

It was sold under the brand name of Veklury. It is also available in the market with other brand names like Remdac, Redyx, Covifor, and Cipremi.

Remdesivir uses

A Journey of Remdesivir – 

Remdesivir is firstly developed in 2009 to cure Hepatitis C, but it didn’t work as expected. 

Later, it was found limited effects against the Ebola virus. It also proved safe use in people. 

Eventually, Remdesivir has shown potent effects against coronavirus such as SARS (Severe acute respiratory syndrome) and MERS (Middle East Respiratory Syndrome). 

After that, some clinical trials were conducted and shown remdesivir’s efficacy against COVID-19

In May 2020, US-FDA approved Remdesivir as off-label use against COVID-19 infection. Now, it is using only in emergency for treatment of COVID-19.

According to WHO, remdesivir may be used as a conditional recommendation in hospitalized COVID-19 patients. It means Remdesivir should be used by assessing the benefit-risk ratio. 

 

When should Remdesivir be given?

Recently, a new clinical guideline has been issued from AIIMS/ICMR on 22nd April 2021. 

This guideline has suggested specific treatment for COVID-19 based on the severity of diseases – mild, moderate, and severe cases. Besides, it is recommended that remdesivir should be used only in particular circumstances. 

So, remdesivir may be considered only in case if you have –

  • moderate to severe disease, and 
  • no kidney or liver dysfunction, and  
  • symptoms occurring from last10 days

 

Is Remdesivir effective in treating COVID-19?

According to a study published in The New England Journal of Medicine, Nov. 2020 suggests Remdesivir may treat COVID-19. 

It was a gold standard study (double-blinded randomized controlled trials). In this 10-day study, remdesivir was compared with placebo.

It was found some efficacy against COVID-19 infection. Moreover, it helps decrease the mortality rate. 

In another study published in Reviews in Medical Virology, Oct 2020 – it was observed that remdesivir improves the recovery rate in hospitalized COVID-19 patients. 

 

What are the side effects of remdesivir?

As far as the concern about the safety of remdesivir. The most common side effects of remdesivir are nausea, vomiting, and diarrhea, as per the article published in Elsevier (biomedicine and pharmacotherapy, 2020).

Besides, there are some rare side effects associated with remdesivir found in the study – 

  • Hypotension
  • Atrial fibrillation
  • Hypernatremia 
  • Acute renal failure

 

So, you may need continuous monitoring of heart and kidney function. 

Another study observed that remdesivir may slightly increase liver enzymes like ALT (alanine aminotransferase) or AST (aspartate aminotransferase) and make your liver dysfunctional.

If you have a liver disease like jaundice, hepatitis, fatty liver disease, etc., you should inform your doctor. 

 

How coronavirus replicate in our body?

When coronavirus enters your body, its outer spikes (s-protein) act on ACE-2 (Angiotensin-converting enzyme-2) receptors. 

Generally, the ACE-2 receptor is most abundantly found in the epithelia of your lung and small intestine. These receptors provide a possible route for coronavirus.

 

 

Coronavirus is a single-stranded viral RNA. This virus enters your cell through the endocytosis process. Once the viral RNA inside the cell, it hijacks your host cell machinery like ribosome

The ribosome has the primary function of making protein. It is also known as protein factory of the cells. You can understand it as a photocopy machine. 

The virus takes over this photocopy machine (ribosome). Then, it makes multiple copies of viral RNA through the RdRP enzyme (RNA-dependent RNA polymerase). 

RdRP helps in increase the process of making viral protein. As a result, this viral protein makes more coronavirus. 

Eventually, ribosome dramatically reduces the production of your own protein and starts to produce only viral protein. 

Due to this, your immune system inhibits and worsens the condition.  

 

How does remdesivir work against covid-19?

Remdesivir is a prodrug of an adenosine analog. In other words, remdesivir is an inactive form of the drug. 

When you get remdesivir via intravenous. It reaches into your cells and metabolizes into its active form GS-441524 (C-adenosine analog).

Generally, viral RNA is made up of nucleotide bases (adenosine, guanine, cytosine, and uracil). 

When the virus looks GS-441524 metabolite in the cell, the viral RdRP enzyme gets confused because this metabolite looks like C-adenosine analog. 

It takes remdesivir’s metabolite analog by mistake and incorporates it into the synthesis of the viral RNA strand. Later, it becomes defective to make a complete viral RNA chain.  

In this way, remdesivir inhibit the synthesis of viral RNA. 

 

Conclusion

Remdesivir is an RNA polymerase inhibitor. It is an investigational drug because many clinical trials are already going on to assess the efficacy and safety of remdesivir. 

However, there is limited evidence of remdesivir uses against COVID-19, but it is not a lifesaving drug. We cannot strongly rely on this medicine. 

It should not be used in early symptoms, mild or asymptomatic cases of infection. 

Since we don’t have good antiviral medicine against coronavirus. It should be used only in specific circumstances like moderate to severe covid infection because it is the only hope which helps to treat COVID-19. 

So, Remdesivir cannot be used as a primary treatment for corona infection until stronger evidence gets. 

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