In January 2020, a new coronavirus emerged as a serious threat to the world health. SARS-CoV-2 causes a flu-like syndrome in 90% of the cases, but 10% of the cases are characterized by a severe viral pneumonia, which may need intensive care. Currently, there are no specific antiviral treatments for CoV in humans. Attempt to treat patients with approved antivirals, such as ribavirin and lopinavir, and immunomodulators, such as corticosteroids and interferon, have failed to demonstrate effectiveness in randomized controlled trials.

Remdesivir is a small molecule monophosphoramidate prodrug of an adenosine analog. It carries out its action by inhibiting the RNA-dependent RNA-polymerase through its nucleoside component, after being activated to a triphosphate. Several in vitro studies demonstrated the activity of RDV against a variety of coronaviruses, including SARS-CoV-2.

Here we review remdesivir, a novel broad-range antiviral molecule, developed for use against Ebola Virus, with demonstrated in vitro antiviral activity against coronaviruses. We aim to summarize evidences and recommendations for its use against COVID-19.