This week’s drug of the week features Remdesivir, an antiviral drug approved for the treatment of COVID-19. Check out my previous post .
Date of Approval by FDA: 22 October 2020.
Common name: Veklury
Mode of administration: An infusion obtained by reconstituting a vial containing 100 mg of Remdesivir. It must be given as an intravenous injection and not as an intramuscular injection.
Who can take this injection?
Indications include treatment of COVID-19 in
- Adults who have pneumonia who may or may not need supplemental oxygen
- Children who have pneumonia who may or may not need supplemental oxygen
Mechanism of Action
Remdesivir is a prodrug of Adenosine nucleotide. A prodrug is an inactive form of a drug that converts to an active form in the body after injection. It converts to its pharmacologically active form of Adenosine Nucleotide Triphosphate metabolite, also known as remdesivir triphosphate. It competes with the natural ATP for substrate and binds to nascent RNA chains with the help of SARS-CoV-2 RNA-dependent RNA polymerase. This delays the chain termination step of viral RNA. In addition, remdesivir also inhibits the synthesis of viral RNA.
The above information is taken from the spmc of the drug.
Latest research
Remedesivir and SARCoV-2
Severe Acute Respiratory Syndrome- COVID-19 (SARS Cov-2) is a more serious version of COVID-19. It primarily affects immunocompromised patients and is hence high risk. They are usually prescribed drugs that directly act on the virus like monoclonal antibodies. However, a combination therapy shows favorable results compared to a single direct-acting treatment. According to the study, Remdesivir along with a combination of Nirmatrelvir and Ritonavir was more effective than any of those with Molnupiravir. So, Remdesivir is a crucial drug in the combination therapy useful for the treatment of COVID-19 in high-risk patients.
Remdesivir effects on minority population
COVID-19 has impacted certain races, ethnicities, and socioeconomic groups differently. Among the factors that influence COVID-19 are underlying comorbidities, age, sex, socioeconomic factors, treatments, virus pathogenicity, and vaccination status. However, data on the effect of Remdesivir (a commonly prescribed drug for COVID-19) on the minority population, for instance, Black and Latin populations is insufficient. This study did just that. Among a total of 206 patients, it was effective in most patients except in those with traditional comorbidities like the older population or patients with diabetes mellitus. This study mainly shed light on the effect of Remdesivir on the minority population.
Remdesivir and COVID situation in Spain
We will soon be reaching five years of COVID and Spain is still witnessing many cases of COVID-19. A report was recently published on the same. According to the report, Paxlovid ( a combination of Nirmatrelvir and Ritonavir) is a frequently prescribed antiviral drug. However, many are not prescribed this drug mainly citing the drug-to-drug interaction and a potential chance of relapse. Due to the short half-life of Nirmatrelvir, it is prescribed along with Remdesivir. It is mainly given to admitted patients who do not require supplemental oxygen.
Remdesivir and Paediatric population
A research team from Doha, Qatar carried out a case-controlled study on the efficacy and safety of Remdesivir on Paediatric COVID-19. This study was necessary as there was limited data available because most clinical studies focussed on adults. The team studied 60 pediatric patients below the age of 14. Among them, 38 received RMV and 22 received no drug (control group). The findings suggest that Remdesivir is well tolerated in the pediatric population and may be a viable option.
Remdesivir mechanism at an atomic scale
The currently known mechanism of action of Remdesivir involves its interaction with the growing strand of RNA using Watson and Crick Hydrogen bonds with Uridine of the opposite strands. The strength of this interaction gives Remdesivir its efficacy. This crucial interaction has not been studied at an atomic scale but is important as it affects the efficacy of the drug. Using different computational and chemistry techniques, they conclude that RDV is very similar in structure, energy, and h-bonding to Adenosine.
The above finding suggest Remdesivir as an efficient antiviral drug which can be used for the treatment of COVID-19 among all age groups and ethnicities.
Thanks for sharing!