Yan Daisy, Ra One Hyuk, Yan Bingfang
Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Philadelphia, PA 19107 USA.
Department of Anesthesiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 USA.
Anim Dis. 2021;1(1):15. doi: 10.1186/s44149-021-00017-5. Epub 2021 Sep 7.
Infectious pandemics result in hundreds and millions of deaths, notable examples of the Spanish Flu, the Black Death and smallpox. The current pandemic, caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), is unprecedented even in the historical term of pandemics. The unprecedentedness is featured by multiple surges, rapid identification of therapeutic options and accelerated development of vaccines. Remdesivir, originally developed for Ebola viral disease, is the first treatment of COVID-19 (Coronavirus disease 2019) approved by the United States Food and Drug Administration. As demonstrated by and preclinical studies, this therapeutic agent is highly potent with a broad spectrum activity against viruses from as many as seven families even cross species. However, randomized controlled trials have failed to confirm the efficacy and safety. Remdesivir improves some clinical signs but not critical parameters such as mortality. This antiviral agent is an ester/phosphorylation prodrug and excessive hydrolysis which increases cellular toxicity. Remdesivir is given intravenously, leading to concentration spikes and likely increasing the potential of hydrolysis-based toxicity. This review has proposed a conceptual framework for improving its efficacy and minimizing toxicity not only for the COVID-19 pandemic but also for future ones caused by remdesivir-sensitive viruses.
传染性大流行导致数亿人死亡,西班牙流感、黑死病和天花就是显著例子。当前由严重急性呼吸综合征冠状病毒2(SARS-CoV-2)引起的大流行,即使在大流行的历史范畴内也是前所未有的。这种前所未有的特点包括多次激增、治疗方案的快速确定以及疫苗的加速研发。瑞德西韦最初是为埃博拉病毒病研发的,是美国食品药品监督管理局批准的首个用于治疗2019冠状病毒病(COVID-19)的药物。正如[具体研究]和临床前研究所表明的,这种治疗药物具有高效性,对多达七个病毒家族的病毒甚至跨物种病毒都有广泛的活性。然而,随机对照试验未能证实其疗效和安全性。瑞德西韦改善了一些临床症状,但并未改善诸如死亡率等关键参数。这种抗病毒药物是一种酯/磷酸化前药,过度水解会增加细胞毒性。瑞德西韦通过静脉注射给药,导致浓度峰值,并可能增加基于水解的毒性的可能性。本综述提出了一个概念框架,不仅用于提高其在COVID-19大流行中的疗效并将毒性降至最低,也用于未来由对瑞德西韦敏感的病毒引起的大流行。
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