Researchers urge caution with remdesivir as COVID-19 treatment

Research from the University of Cincinnati contends that this antiviral drug is being used too indiscriminately when treating patients hospitalized with the virus, according to a new study published in the journal Fundamental & Clinical Pharmacology.

Remdesivir is the first and only antiviral agent of its kind that the U.S. Food and Drug Administration (FDA) has approved so far for COVID-19. The drug was granted emergency use authorization in May 2020 to treat COVID-19 and granted full approval for treatment in October 2020. The World Health Organization came out in November 2020 with a conditional recommendation advising against its use entirely, stating, “more research is needed, especially to provide higher certainty of evidence for specific groups of patients.”

For the current study, researchers found that the drug permanently stops the activity of an enzyme called CES-2, which is found in the intestine, liver, and kidney, and is needed for the breakdown of many medications.

An antiviral is a drug against viruses and an anticoagulant is a drug that hinders the clotting of blood. What further complicates the issue, the researchers said, is that when delivered through an IV, remdesivir does not treat the virus unless the body has additional specific enzymes, which are not found in all patients. It can also cause other antiviral drugs, such as those used for HIV/AIDs and hepatitis C, to not work properly.

Remdesivir is only administered through the veins in a hospital setting, with the FDA typically recommending a dose of once a day, for approximately 10 days, and intravenous injection of remdesivir can cause safety concerns because of high initial concentrations of the drug in the system, the researchers said.

“If physicians use it, they have to use it with caution,” said Bingfang Yan, DVM, PhD, study lead author and a pharmaceutical scientist, in a statement. “Clearly, the treatment should be used for the right patients and in the proper dosages with care when used in combination with other medications.”

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