1.1 Broad-spectrum antiviral drug -Remdesivir
Currently, remdesivir is a potential drug against SARS-CoV-2 that is being tested in randomized control trials. It is approved by the USFDA for emergency medicine treatment. Remdesivir (formerly GS-5734) is a monophosphate prodrug, which is metabolized to produce active C-adenosine nucleoside triphosphate analogues. The drug was found in the process of screening antibiotics with anti-RNA virus activity. It has a low EC50 and its selectivity to the host polymerase of the Ebola virus has developed drugs for the treatment of Ebola infections (Siegel et al., 2017). Remdesivir is a potential therapeutic agent for COVID-19 because of its broad-spectrum of activity and effective in vitro antivirus activities.
According to previous data, remdesivir has a strong EC90value (1.76 μM) against COVID-19 in Vero E6 cells, and remdesivir also inhibited human hepatoma cell line (human liver cancer Huh-7 cells), which is sensitive to COVID-19 (M. Wang et al., 2020). The first COVID-19 patient diagnosed in the United States has an improved clinical status after intravenous injection of remdesivir (Holshue et al., 2020). Three other hospitalized patients, with worsening clinical status, received remdesivir, which inhibits viral replication by incorporating into the nascent viral RNA and inhibiting the RNA-dependent RNA polymerase (Mulangu et al., 2019). Meanwhile, in vitro studies show that remdesivir inhibits SARS-CoV-2 replication in non-human cells (”Clinical and virologic characteristics of the first 12 patients with coronavirus disease 2019 (COVID-19) in the United States,” 2020). There are successful case reports of remdesivir against COVID-19 infections. There are 66 ongoing clinical trials to assess the drug’s safety and antiviral activity in patients with mild, moderate, or severe COVID-19 (Sanders, Monogue, Jodlowski, & Cutrell, 2020). However, among the crippling side effects of remdesivir, the commonest one is a reversible increase in transaminases, which may cause kidney damage (Sheahan et al., 2020). Therefore, its use still needs to be based on the specific clinical situation of the patient (Table 1).