Remdesivir: A Quick Review of Pharmacotherapy

Abstract

Background:: In the year 2009, Remdesivir or Veklury was discovered by Gilead Sciences for the management of hepatitis C, Ebola and Marburg virus disease through injection into a vein and then a few years later, 22nd Oct 2020 (United States), the drug was recommended for the management of COVID-19 under a provisional guideline. Objective:: The aim of this systematic review was to address pharmacotherapy approaches associated with the efficacy and side effects of remdesivir for the treatment of viral infections. Methods:: This is a focused, in-depth consequent guide approach and literature search, with a methodical assessment associated with the terms “Remdesivir,” “ Remdesivir Bioavailability,” “Remdesivir and Disease,” “ Remdesivir and COVID-19” that was done through Pubmed, Scopus, and Web of Science from their inception to 2023. Results:: 105 studies included in silico, in-vivo, and in-vitro experiments to test remdesivir therapeutic efficacy were selected based on the current, knowledgeable, and high-quality topics of manuscripts. Regarding efficacy, in addition to COVID-19, remdesivir shows therapeutic efficacy in other virus infections, such as hepatitis C, Ebola, and Marburg. In patients with COVID-19, remdesivir shortens the time to recovery, lowering progression to mechanical ventilation and decreasing hospital resources. Combination with dexamethasone in selected patients who need minimal conventional oxygen but are at high risk of severe COVID-19 was reported beneficial. Combination with chloroquine or hydroxychloroquine may cause a decrease in the antiviral activity of remdesivir, but dexamatason reported minimal or no reduction in drug exposure. However, synergistic effects were reported in combination with favipiravir, but methotrexate toxicity needs to be evaluated. Significant improvement in 'patients' conditions was reported in combination with methylprednisolone pulse therapy. Infusion-related reactions such as nausea, elevated liver enzymes, sweating, and hypotension are the most common side effects. Conclusion:: Different studies showed that with remdesivir pharmacotherapy, in addition to significant improvement in the recovery rate in those with COVID-19, the risk of adverse effects was significantly lower than in the control groups. To verify efficacy and side effects, besides attentive consideration of kidney and liver function, further evidence-based pharmacotherapy studies of remdesivir seem advantageous.