Author links open overlay panelThe Lancet Infectious Diseases, & The Lancet Infectious Diseases. (2020, September 10). Curing COVID-19. Retrieved from https://www.sciencedirect.com/science/article/pii/S1473309920307064
https://doi.org/10.1016/S1473-3099(20)30706-4

University of Michigan - Ann Arbor

Remdesivir is a nucleotide analog that inhibits viral RNA-dependent RNA polymerase (RDRP) and has strong potential to be a therapeutic for COVID-19. 
Replication of the single-stranded RNA genome of SARS-CoV-2 depends on an RDRP. Remdesivir is a prodrug that, after metabolized to remdesivir triphosphate, acts as an analog of ATP, competing for incorporation by RDRP and interfering with viral RNA replication.

There have been successful case reports for the drug’s use against COVID-19, and clinical trials are continuing to evaluate its safety and efficacy. In fact, the National Institution of Health (NIH) is currently conducting an adaptive, randomized, double-blind placebo-controlled trial with remdesivir. The drug at this time is not currently FDA approved. Therefore, it can only be obtained by compassionate use, expanded access, or enrollment in a clinical trial.  


Remedesivir may reduce time for clinical improvement and decrease mortality. It has no effect on need for ventilation or length of hospital stay.

Remdesivir as a treatment for COVID-19


Though severe COVID-19 infection leads to acute kidney injury in 20%-40% of critically ill patients and people with end-stage kidney disease have a higher risk of both exposure and severe infection, the effects of remdesivir have not been tested on patients with renal impairment due to eGFR cutoffs. In patients with normal kidney function, 74% of remdesivir and its active metabolite are renally eliminated. There are concerns that the accumulation of both redesivir and its carrier (sulfobutylether-β-cyclodextrin) will be overly toxic in patients who cannot eliminate them as effectively (i.e. patients with kidney disease). Data from a randomized controlled trial did not show strong evidence of an increased risk of renal adverse events even though kidney injury has been shown to develop in rhesus monkeys who were given a considerably high amount of remdesivir. Oral voriconazole is generally preferred for patients with renal failure, but remdesivir (which is administered intravenously) may be necessary if the patient’s oral absorption is limited. In cases like these, the benefits of remdesivir may outweigh the risks. 

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