Coronavirus Disease 2019 Treatment: A Review of Early and Emerging Options

McCreary, Erin K; Pogue, Jason M

The therapeutic efficacy of remdesivir was first described in an animal model against Ebola among infected rhesus monkeys in which once-daily dosing resulted in suppression of viral replication and protection from lethal disease [9] . However, in a human study, remdesivir-treated patients with Ebola experienced a 28-day mortality rate of 53% in a randomized controlled trial of 4 experimental therapies conducted in response to the Democratic Republic of Congo outbreak of 2018, resulting in early termination of this study arm [10] . It is worth noting that this trial did not have an active control arm, and mortality rates for the other experimental treatments were 49.7% (ZMapp), 35 .1% (Mab114), and 33.5% (REGN-EB3). Against MERS-CoV, Sheahan et al [5] evaluated the therapeutic efficacy of remdesivir among infected mice and found treatment significantly reduced virus lung titers, weight loss, lung hemorrhage, and lung injury scores. The authors proposed the importance of early therapy initiation to diminish virus replication and promote pulmonary repair because remdesivir demonstrated less clinical benefit with high-titer virus inoculum. Most notably, the authors also noted that prophylactic remdesivir diminished MERS-CoV replication and disease, which was similar to their findings in a murine model with SARS-CoV-1 [5, 6] .