To the Editor,
The abrupt emergence and spread of SARS-COV-2 has taken the world by surprise. There is a global search for treatment. One of the most promising is remdesivir, a drug developed to treat Ebola virus (of which it did not) that has not yet been fully studied. The preliminary reports indicate activity versus COVID-19 and some efficacy.
Remdesivir reminds one of other viruses and another drug. The AIDS epidemic also took the world by storm, first recognized in 1981 and without any “proven” treatment for several years. A drug, 3′-deoxy-3′-aido-thymidine, sitting on the shelves of the National Cancer Institute since the 1960s when it failed as a chemotherapeutic agent against cancer, was tested and shown to have beneficial effects at shutting down HIV replication in the laboratory and in a limited trial. In 1986 a randomized clinical trial documented that it did stop HIV. This compound, named “zidovudine,” rapidly entered clinical use, although there were skeptics. Unfortunately, zidovudine was potentially toxic, and its benefit was short-lived, as the HIV would escape control through mutation. But zidovudine did show the way; many other drugs followed; and in 1996, thanks to the benefit of new assays and laboratory tools to guide treatment, we were able to combine drugs and achieve lasting control of HIV. A different virus, a different epidemic, but a similar first step, although, as of this writing, we are unsure if this will end the lethal effects of COVID-19 infection.
Remdesivir is a nucleoside analog of adenosine that was developed by a research team at Gilead searching for a treatment for Ebola virus. The drug did not work for Ebola, although the studies indicated that it was a safe drug. Work with the corona viruses suggested activity in vitro and in monkeys, and we now have some anecdotal information and the initial human trials that suggest activity.1
There are three studies now available:
There are several reservations:
As of May 5, 2020, Remdesivir appears to be a relatively safe drug that currently has been christened the standard or treatment for severe COVID-19 disease4, but whether it remains so is not at all clear. As was the case with zidovudine for HIV, it may be only the initial therapy that will be replaced by more effective regimens in the near future.