Uso clínico del Remdesivir en COVID-19. Una Revisión de la literatura.

RDV antiviral activity

  • Mónica Calderón-Barrera Pontificia Universidad Javeriana Cali
  • Denis Alejandro Morales Pontificia Universidad Javeriana Cali
  • Isaac Arbeláez-Quintero Pontificia Universidad Javeriana Cali https://orcid.org/0000-0002-8846-7275
Palabras clave: Remdesivir, SARS-CoV-2, COVID-19, Antiviral, Análogo nucleósido, RNA polimerasa

Resumen

Remdesivir es un antiviral desarrollado por Gilead Sciences que actúa como análogo nucleósido inhibitorio de la RNA polimerasa viral (RdRp). Propuesto como tratamiento para el manejo de pacientes con COVID-19 a raíz de resultados prometedores en estudios in vitro con Coronavirus humanos (SARS-CoV, MERS-CoV, SARS-CoV-2). Varios estudios clínicos en curso y resultados preliminares en pacientes con enfermedad moderada y severa sugieren una reducción en el tiempo de enfermedad con el tratamiento por 5 o 10 días, una señal de posible reducción de mortalidad en el subgrupo de pacientes hospitalizados con oxigeno a bajo flujo, pero ausencia de efecto en los pacientes con enfermedad más severa y en población asiática. La farmacodinamia del Remdesivir y la fisiopatología del COVID-19 son cruciales para la comprensión de su aplicabilidad clínica: la inhibición de la replicación viral es importante en estadíos iniciales, mientras que en etapas avanzadas de la enfermedad predomina un fenotipo proinflamatorio/protrombótico; los resultados de los estudios en curso deberán dar luz al fenotipo de pacientes con COVID-19 que más se beneficia de recibir este medicamento. En este artículo realizaremos una revisión sobre la farmacología y la evidencia clínica y preclínica disponible hasta la fecha sobre el Remdesivir en busca de tratamientos para la actual pandemia por COVID-19.

Abstract:

Remdesivir is an antiviral medication developed by Gilead, it acts as a inhibitory nucleoside analog of viral RNA polymerase (RdRp). Proposed as a treatment for COVID-19 due to promising results of in vitro studies with human coronaviruses (SARS-CoV, MERS-CoV, SARS-CoV-2). There are various ongoing clinical trials in patients with moderate and severe disease. Preliminary results suggest a reduction in time of clinical recovery on treatment with Remdesevir given on period time of 5 or 10 days. There’s also a sign for a mortality reduction in subgroup analysis and absence of evident benefit in patients with more severe disease and Asian population. Remdesivir’s pharmacodynamics and COVID-19’s pathophysiology are crucial for the understanding of its clinical applicability: inhibition of viral replication is important in the early stages, while inflammation/cytokine storm/thrombosis predominate in severe disease; the results of ongoing trials should give light to the question of which phenotypes disease benefits clinically from this treatment. In this article we review the pharmacology of Remdesivir and also it’s available clinical and preclinical evidence on the search for a treatment for the ongoing COVID-19 pandemic.

Key words: Remdesivir, SARS-CoV-2, COVID-19, antiviral, nucleoside analogue, RNA polymerase.

Biografía del autor/a

Mónica Calderón-Barrera, Pontificia Universidad Javeriana Cali

Médica, Residente Especialización en Medicina Familiar.

Denis Alejandro Morales, Pontificia Universidad Javeriana Cali

Médico, Residente Especialización en Medicina Familiar.

Isaac Arbeláez-Quintero, Pontificia Universidad Javeriana Cali

Médico, Magíster en Ciencias Biomédicas, Profesor Departamento de Ciencias Básicas de la Salud.

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Publicado
2020-08-12
Cómo citar
Calderón-Barrera, M., Morales, D., & Arbeláez-Quintero, I. (2020). Uso clínico del Remdesivir en COVID-19. Una Revisión de la literatura. Salutem Scientia Spiritus, 6(1), 149-160. Recuperado a partir de https://revistas.javerianacali.edu.co/index.php/salutemscientiaspiritus/article/view/2377