Elucidation of the Pharmacological Development and Action Mechanism of Remdesivir and Paxlovid in Combatting COVID-19

Abstract

COVID-19, the disease identified in 2019 as coronavirus disease, stems from an infection by severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, which possesses a single-stranded RNA genome. Since the onset of the pandemic attributed to COVID-19, a variety of vaccines and antiviral medications have received approval from international regulatory bodies. Two notable antiviral agents, remdesivir and paxlovid, serve as treatments for viral infections. Initially developed to combat Ebola, remdesivir has also demonstrated efficacy against a broad spectrum of coronaviruses (CoV). It is a nucleoside analogue and functions by being incorporated into the RNA chain of the virus and thus induce the early termination of RNA synthesis. Paxlovid comprises two pharmacological agents, nirmatrelvir and ritonavir. The mechanism of nirmatrelvir involves the specific targeting and inhibition of the viral protease’s active site, thereby impeding the viral replication process. By inhibiting the cytochrome CYP3A4 enzyme which metabolites nirmatrelvir, ritonavir acts as a pharmacokinetic enhancer in this combination. The initial section of this review provides a comprehensive analysis of SARS-CoV-2, detailing the mechanisms of its pathogenesis and the subsequent immune responses elicited by the body. Then this article generalizes the history of development, the structure, and the mode of action of remdesivir and paxlovid.