Both Gilead and Pfizer are working to increase their production of Remdesivir to distribute the drug in the US and around the world. Gilead signed agreements with nine manufacturing companies to increase remdesivir availability in 127 low-income and lower-middle-income countries. 



Production of Remdesivir in North America 

Smith College

Remdesivir, an antiviral drug developed by Gilead Sciences, has been evaluated in multiple clinical trials for treating COVID-19. Preliminary studies raised expectations for its efficacy, and it was granted emergency-use authorization to treat severe infections in the U.S. and Japan. Key findings on Remdesivir as a COVID-19 intervention include: early randomized trials unable to show reduced time to clinical improvement, viral clearance, or mortality; adverse health effects; study results on Remdesivir's benefits; availability constraints; global production; global clinical trial locations; and intracellular drug processing.

Findings about use of Remdesivir as COVID-19 intervention

Although initial observational studies suggested high hopes for drug efficacy, a randomized, double-blind, placebo-controlled clinical trial was unable to prove statistical significance for reducing the following among severe COVID-19 patients hospitalized in Wuhan, China:
- Clinical improvement
- Clearance of virus
- Mortality rates
The investigators were forced to stop the study early after no additional patients met the eligibility criteria. The trial was deemed underpowered (58% power), therefore limiting study findings.

Early randomized trials are unable to provide evidence for reducing time to clinical improvement, clearance of virus, or mortality amongst those given Remdesivir as COVID-19 intervention

- Usage of remdesivir has been associated with various adverse health effects, including liver damage and gastrointestinal issues, such as vomiting or nausea.

102/155 (66%) of remdesivir recipients in a clinical trial conducted among severe COVID-19 patients in Wuhan, China reported adverse health effects.
“The most common adverse events in the remdesivir group were constipation, hypoalbuminaemia, hypokalaemia, anaemia, thrombocytopenia, and increased total bilirubin; and in the placebo group, the most common were hypoalbuminaemia, constipation, anaemia, hypokalaemia, increased aspartate aminotransferase, increased blood lipids, and increased total bilirubin.”

Adverse health effects amongst those given Remdesivir as COVID-19 intervention

Remdesivir is the only drug other than dexamethasone shown to benefit those infected with COVID-19 in a large, randomized trial. It shortened the amount of time patients needed to spend in the hospital, but it did not have a statistically significant benefit in preventing deaths. It is the only drug that has gained emergency use authorization from the US FDA. 

Study results concerning remdesivir benefits in COVID-19

Remdesivir is in short supply and is only available in a limited number of hospitals worldwide. Additionally, it is difficult to administer (via injection over a few days).

Availability of remdesivir

This map shows the locations of the numerous, ongoing clinical studies of Remdesivir around the world. Listed below the map are the number of sites participating in each study. 


Clinical trials of Remdesivir around the world 

- Figure a shows the chemical structure of a 1′-CN modified adenosine C-nucleoside in blue (GS-441524) and Remdesivir; GS-441524 makes up the core of Remdesivir 

- Figure b shows the intracellular processing of Remdesivir. After diffusion into the cell, Remdesivir is metabolized into the nucleoside monophosphate via a series of steps that are believed to be triggered by esterase-mediated hydrolysis of the amino acid ester which in turn frees a carboxylate that cyclizes onto the phosophorus displacing the phenoxide. The reactive cyclic anhydride is hydrolysed by water to produce the alanine metabolite, whose P-N bond is hydrolysed by phosphoramidase-type enzymes to free the nucleoside monophosphate. The monophosphate then undergoes further phosphorylation events to produce the active nucleoside triphosphate, which is used by the viral RNA-dependent RNA polymerase (RdRp). RdRp uses the triphosphate to inhibit viral replication by inducing delayed chain termination. 


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