Remdesivir in COVID-19: A critical review of pharmacology, pre-clinical and clinical studies.

Remdesivir is a broad spectrum anti-viral drug that has shown to inhibit SARS-CoV-2, in vitro and in vivo. In absence of any effective treatment for SARS-CoV-2 infection (COVID-19), remdesivir has been tried for a compassionate use in severe COVID-19. Newer randomized controlled studies that have recently become available, showed a mixed result. We aimed to systematically search the literature to understand the pharmacology and clinical effects of remdesivir in patients with COVID-19. We systematically searched the PubMed, ClinicalTrial.Org and MedRxiv database up till May 5, 2020 using specific key words such as "Remdesivir" or 'GS-5734″ AND "COVID-19" or "SARS-CoV-2" and retrieved all the article published in English language, that have reported the pharmacology and the clinical outcomes of remdesivir in patients with COVID-19. Initial compassionate use of remdesivir has shown a fairly good result, but difficult to quantify, in the absence of control arm. While the very first double-blind, placebo-controlled, randomized trial conducted in Wuhan, did not find any significant benefit compared to the control, the preliminary result of another similar multi-country trial has shown a significant faster time to recovery but without any difference in mortality. Remdesivir has shown a mixed result in patients with COVID-19 with an acceptable side effect. However, jury is still out while awaiting the results from the forthcoming trials. • Remdesivir has been recently given an Emergency Use Authorization for in-patients use in severe COVID-19 in both adults and children. • While the first double-blind, randomized-controlled trial (DBRCT) found no significant benefit with remdesivir compared to placebo, preliminary reports from another DBRCT showed a significant faster recovery, without any difference in mortality. • Interestingly, a short 5-days course of remdesivir was found to have a similar efficacy to a long 10-days course with a lesser side effect. [ABSTRACT FROM AUTHOR]