Great to see the recent early clinical trial results for Remdesivir showing some benefit in a small study of hospitalised infected patients.(1)
The results of larger more detailed trials will be eagerly awaited. If effective the need to supply significant amounts of this drug will be essential.
The synthesis of Remdesivir is a long linear process, although the cost per dose is relatively cheap. Gilead have made significant improvements to the manufacturing route, reducing it from one year to six months.(2)
If Remdesivir is shown to be effective in larger trials, the demand for the drug will significantly outstrip the ability to supply.
Gilead stated they currently have ~1.5 million doses available, which could provide ~140,000 treatment courses. As the global population is ~7 billion, then supply needs to be significantly increased.(3)
The drug was originally designed to be given as an intravenous infusion, meaning anyone receiving treatment would need this to happen in a suitably conducted environment.
In order to allow greater dosing to the general population, assessment of the ability to dose the drug orally, or via a more straightforward manner need to be looked into, as a matter of urgency. Reformulation or other dosing regimens might provide suitable alternatives.
As mentioned in our last post, it would be great to see the chemistry community working collaboratively to come up with alternative approaches that could impact supply of this and other potentially pivotal drugs in the fight to keep this virus contained.
(1) Data on 53 Patients Treated With Investigational Antiviral Remdesivir Through the Compassionate Use Program Published in New England Journal of Medicine – https://www.gilead.com/news-and-press/press-room/press-releases/2020/4/data-on-53-patients-treated-with-investigational-antiviral-remdesivir-through-the-compassionate-use-program-published-in-new-england-journal-of-medici
(2) Working to Supply Remdesivir for COVID-19 – https://www.gilead.com/purpose/advancing-global-health/covid-19/working-to-supply-remdesivir-for-covid-19
(3) 1.5 Million Doses of Experimental Coronavirus Drug Remdesivir Donated by Biotech Firm Gilead – https://www.newsweek.com/15-million-doses-experimental-coronavirus-drug-remdesivir-donated-biotech-firm-gilead-1496247