# SARS-CoV-2 Treatment: Current Therapeutic Options and the Pursuit of Tailored Therapy
## 4 Antiviral Therapy  
_Rendesivir_  
Remdesivir is an adenosine analogue, a prodrug, that is administered intravenously and binds the RNA dependent-RNA polymerase and blocks the protein activity (Tables 2 and 3) [4; 13; 14]. * Emergency Use Authorization for other categories. CCs, corticosteroids; IL, interleukin; IV, invasive mechanical ventilation; JAK, Janus kinases; NF-kB, nuclear factor kB; OD, once daily; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; TD, twice daily. \end{table}
Table 2: Rationale, current clinical indications and dosages of COVID-19 drugs. According to the National Institutes of Health (NIH) guidelines, remdesivir is the only antiviral drug approved for COVID-19 and it is recommended for patients \(\geq\)12 years and weighing \(\geq\)40 kg or in Emergency Use Authorization (EUA) for other categories. Early evidences about its use in pregnancy seem to be positive [34]. It can be used: alone (or optionally adding dexamethasone) in hospitalized patients who need supplemental oxygen, without the need of other devices; in exclusive combination with dexamethasone in patients requiring a high flow nasal cannula (HFNC) or non-invasive ventilation (NIV). It is not used in people who need invasive ventilation (IV) or extracorporeal membrane oxygenation (ECMO) [4]. Remdesivir can be also administered with baricitinib in patients who need supplemental oxygen, HFNC or NIV, but not in patients who need IV or ECMO. In unhospitalized patients who need IV or ECMO, HFNC or NIV, the authors are aware of the presence of a high flow nasal cannula (HFNC) or non-invasive ventilation (NIV). It is not used in people who need invasive ventilation (IV) or extracorporeal membrane oxygenation (ECMO) [4]. patients with mild to moderate COVID-19, there are insufficient data to recommend these drugs [4]. In a compassionate study of 53 patients hospitalized for severe COVID-19, [PERSON] et al. [32] after an 18-day follow-up, documented that 36 patients (68%) had an improvement in oxygen-support class, including 17 of 30 patients (57%) receiving mechanical ventilation who were extubated. A total of 25 patients (47%) were discharged, and seven patients (13%) died, suggesting that remdesivir could be used in hospitalized patients with severe disease. In a double-blind, randomized controlled trial [PERSON] et al. [16] reported a reduced time to recovery in hospitalized COVID-19 patients treated with remdesivir for ten days compared with the placebo (median time to recovery 10 days (95% confidence interval [CI] of 9-11 days) vs. 15 days (95% CI, 13-18 days)). Moreover, in a 14-day follow-up during an interim analysis of patients with severe COVID-19, [PERSON] et al., documented a clinical recovery (based on improvement on a 7-point ordinal scale) in 74.4% of patients enrolled in remdesivir group vs. 59.0% in non-remdesivir group (adjusted odds ratio (OR), 2.03; 95% CI, 1.34-3.08; \(p<0.001\)). However more recently, the same authors [52] performed a final day-28 comparative analysis of the data that were previously analyzed [53], and documented that remdesivir vs. the standard of care improves clinical recovery and lowers mortality from severe COVID-19 (12.0% in remdesivir group vs. 16.2% in non- remdesivir group; OR, 0.67; 95% CI, 0.47-0.95; \(p=0.03\)). Moreover, these data suggest that remdesivir reduces the burden on hospitals during surges in SARS-CoV-2 infections. Adverse drug reactions (ADRs) include diarrhea or gastrointestinal symptoms, rash, renal impairment, increased hepatic enzymes and hypotension, up to multiple organs-dysfunction syndrome and septic shock. These effects were more common in patients receiving invasive ventilation [32]. Headache, phlebitis, constipation, ecchymosis, nausea, and extremity pain were also observed [14].