Mechanism of Action and Clinical Use of Remdesivir in the Treatment of COVID-19

Amol Jadhav, Maaz Aquil, Girish Gore, Nishant Gite, Parth Khandelwal,

doi:10.5281/zenodo.17533702

Review Paper | Open Access
Volume 02 | Issue 11 | Article Id IJSRT/250310147

Mechanism of Action and Clinical Use of Remdesivir in the Treatment of COVID-19
Amol Jadhav* Maaz Aquil Girish Gore Nishant Gite Parth Khandelwal
B. Pharmacy, S.N.D College of Pharmacy, Babhulgaon

Abstract

Remdesivir, a nucleotide analog prodrug originally developed for Ebola virus, emerged as one of the first antiviral agents evaluated for the treatment of COVID-19. It exerts its antiviral activity by inhibiting the RNA-dependent RNA polymerase (RdRp) of SARS-CoV-2, leading to premature termination of viral RNA synthesis. Clinical trials have demonstrated that remdesivir can shorten recovery time in hospitalized patients with moderate to severe disease, particularly when administered early in the course of illness. While it is not a curative treatment, remdesivir plays a supportive role in managing COVID-19, especially in patients requiring oxygen therapy. Its use is guided by clinical status, timing of symptom onset, and evolving treatment protocols. This article reviews the pharmacological mechanism of action, clinical indications, dosing strategies, and therapeutic considerations of remdesivir in the context of COVID-19 management.

Keywords

Remdesivir, COVID-19, Antiviral Therapy, SARS-CoV-2, RNA Polymerase Inhibitor, Drug Repurposing

Introduction

Antiviral therapies play a crucial role in the management of viral infections by targeting specific viral components or processes essential for the replication of the virus. Unlike antibiotics, which target bacteria, antivirals must be designed to inhibit the replication of viruses while minimizing damage to host cells. Over the years, the development of antiviral drugs has focused on key viral mechanisms such as entry inhibitors, protease inhibitors, reverse transcriptase inhibitors, and RNA polymerase inhibitors. Successful antivirals include drugs used for the treatment of HIV, hepatitis B, and influenza (e.g., oseltamivir, lamivudine, and tenofovir) [1]. However, the development of antivirals for coronaviruses remained limited prior to the outbreak of COVID-19. Emergence of Remdesivir in the Context of the COVID-19 Pandemic. The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, led to a global health emergency starting in late 2019. Faced with rapidly increasing infections and a lack of specific treatments, scientists and healthcare professionals turned to drug repurposing as a swift approach to finding therapeutic options. Remdesivir, a nucleotide analog prodrug originally developed to combat Ebola virus, was identified early in the pandemic as a potential therapeutic for COVID-19 due to its broad-spectrum antiviral activity against several RNA viruses, including SARS-CoV-2 and MERS-CoV-2 [2]. In vitro studies demonstrated its ability to inhibit SARS-CoV-2 replication in human lung cells [2]. Given the urgent need for treatments, Remdesivir was rapidly advanced into clinical trials, and by May 2020, it received Emergency Use Authorization (EUA) from the U.S. FDA for the treatment of hospitalized COVID-19 patients [3]. The primary aim of this review is to provide an in-depth analysis of Remdesivir, focusing on its mechanism of action, clinical effectiveness, safety profile, and the challenges associated with its use. While initial studies indicated that Remdesivir could reduce the recovery time for hospitalized COVID-19 patients, its efficacy in reducing mortality has been a topic of debate, with mixed results from global clinical trials. This review will also explore the limitations of Remdesivir, including its variable effectiveness in different patient populations, its high cost, and the challenges of drug accessibility. Finally, we will look at the future directions for the use of Remdesivir, including its potential role in combination therapies and the ongoing investigation of its efficacy against emerging SARS-CoV-2 variants.

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