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This article was last reviewed on 15 October 2021.
Remdesivir – brand name Veklury – is an antiviral drug that was provisionally or fully approved in many countries for treating covid-19 after one trial showed it reduced recovery times in patients getting extra oxygen. However, in November 2020, the World Health Organization (WHO) recommended against its use after a larger trial found no evidence of benefits.
Remdesivir stops some viruses from making copies of their genome, meaning they cannot replicate themselves.
Some viruses, including Ebola and coronaviruses, have a genome made of RNA. Many of these viruses use an enzyme called RNA-dependent RNA polymerase to make more copies of their genome after they infect cells. The enzyme can mistake remdesivir for an RNA building block and add it to the RNA molecule it is making, halting the process before the RNA copy is complete.
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The drug molecule was discovered in 2009 when US pharmaceutical company Gilead Sciences was looking for treatments for hepatitis C. Subsequent lab tests suggested it inhibits several kinds of RNA viruses, including Ebola and various coronaviruses.
In 2018 and 2019, remdesivir was tested in people as a treatment for Ebola, but it did not work as well as two antibodies tested in the same trial.
After the covid-19 pandemic began, several trials were set up to see if remdesivir could help. According to one randomised, blinded trial in the US involving 1063 people, in covid-19 patients with pneumonia requiring extra oxygen it shortens recovery time to 11 days compared with 15 in those given a placebo, but it does not reduce death rates. It was approved for treating covid-19 on this basis in many countries, including the US, UK and the EU.
However, in October a larger trial organised by the WHO found no evidence of any benefits. After analysing data from four trials in November 2020, a WHO panel recommended against its use in hospitalised covid-19 patients, stating that “there is currently no evidence that remdesivir improves survival and other outcomes”.
