Potency and timing of antiviral therapy as determinants of duration of SARS CoV-2 shedding and intensity of inflammatory response

Ashish Goyal; E. Fabian Cardozo-Ojeda; Joshua T Schiffer

Fifth, our approach suggests that while development of low-level drug resistance will occur commonly during COVID-19 treatment with remdesivir, it is unlikely to predispose to treatment failure provided the drug is potent against the predominant susceptible strain. Resistant variants will likely be present at low levels relative to susceptible strains making transmission of resistance far less likely. Important exceptions may occur in immunocompromised hosts who might shed respiratory viruses for longer and at higher levels, thereby increasing the chance of de novo resistance (32) , or in the context of only moderately potent antiviral therapy. Finally, our model projects a high likelihood of success for neutralizing antibodies and cellular immunotherapies provided that they achieve adequate potency and are dosed early.