“Remdesivir has proven anti-viral activity as a viral RNA polymerase inhibitor. This is highly relevant in the context of COVID-19 because in the early stages of disease the virus is the major driver, whereas in severe patients in later stages it appears to be our own immune system overreacting. Although Gilead has been testing remdesivir with immune modulators to tackle the enormous immune reactions that strike patients in the later stage of illness, at least 80% of symptomatic cases are mild to moderate. It is, therefore, no surprise that Gilead is leaning on the success of remdesivir to target this population.

An inhaled formulation administered via nebulizer may allow for easier administration outside the hospital setting, but Gilead may need to reformulate its powdered remdesivir vial to achieve this, as it currently requires reconstitution prior to intravenous administration. Furthermore, the supplying of equipment and nebulizers to each patient will be a large cost barrier."

-Angad Lotay, Infectious Diseases Analyst, GlobalData, UK