New Research Supports Use of Hepatitis C Drug Sofosbuvir in Combination with Remdesivir to Treat COVID-19

Researchers have reported that Sofosbuvir-terminated RNA is more resistant to the proofreader of SARS-CoV-2 than Remdesivir-terminated RNA, supporting the use of the FDA-approved hepatitis C drug EPCLUSA - Sofosbuvir/Velpatasvir - in combination with other drugs in COVID-19 clinical trials.

The SARS-CoV-2 exonuclease-based proofreader maintains the accuracy of viral RNA genome replication to sustain virulence. Any effective antiviral targeting the SARS-CoV-2 polymerase must therefore display a certain level of resistance to this proofreading activity. The new study by researchers at Columbia Engineering (New York, NY, USA) builds upon their earlier work. Last January, before COVID-19 reached pandemic status, the team posited that EPCLUSA might inhibit SARS-CoV-2, the virus responsible for COVID-19. Their reasoning was based on the analysis of the molecular structures and activities of hepatitis C viral inhibitors and a comparison of hepatitis C virus and coronavirus replication.

In a subsequent study, the researchers demonstrated that the active drug Sofosbuvir triphosphate is incorporated by SARS-CoV and SARS-CoV-2 polymerases, shutting down the polymerase reaction. Other investigators have since demonstrated the ability of Sofosbuvir to inhibit SARS-CoV-2 replication in lung and brain cells; currently, COVID-19 clinical trials with a number of hepatitis C drugs such as EPCLUSA and the combination of Sofosbuvir and Daclatasvir (which is similar to Velpatasvir) are ongoing in several countries.

“We found that the RNA terminated by Sofosbuvir resists removal by the exonuclease to a substantially higher extent than RNA terminated by Remdesivir, another drug being used as a COVID-19 therapeutic,” said the team’s lead PI Jingyue Ju, Samuel Ruben-Peter G. Viele Professor of Engineering; professor of Chemical Engineering and Pharmacology; director, Center for Genome Technology & Biomolecular Engineering.

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