Will there be more drugs to treat COVID-19?


The antiviral drug Molnupiravir is in phase 3 clinical trials.
The antiviral drug Molnupiravir is in phase 3 clinical trials.


To wreak havoc on the human body, viruses do a lot of work once they get inside. Fortunately viruses don't have organelles to help them replicate themselves. But, their cells do. Antiviral drugs work by interrupting this process.

Remdesivir, the only drug currently authorized to fight SARS-CoV-2, worked by inhibiting an enzyme the virus needs to replicate. But, the drug Molnupiravir works through deception. While cells will build viral RNA chains, the drug will replace some of the necessary parts. These rogue elements continue to mutate in the newly replicated virus to destabilize it. Pharmaceutical companies Pfizer and Roche are also developing similar antiviral drugs.

“All antivirals are similar in that they block viral replication,” said Bettie Steinberg, a microbiologist at the Feinstein Institute for Medical Research in New York. But, they do it in different ways. If the virus can't replicate on its own, our immune system will overpower it.


Remdesivir should only be given by intravenous (IV) to seriously ill patients being treated in a hospital. In clinical trials, the drug reduced the length of hospital stay of patients from a mean of 15 days to 10 days, but it did not increase the number of patients who survived.

Molnupiravir is taken by mouth, which means that if you test positive for COVID-19, you can take it at home. This drug is taken twice a day, 4 tablets each time and taken continuously for 5 days with a total of 40 tablets.

In the clinical trial, Merck gave molnupiravir to individuals who have had symptoms in the last 5 days and are expected to be at high risk for severe illness, such as those over 60 years of age or older. people with pre-existing conditions such as heart disease and diabetes.

Molnupiravir halved the risk of hospitalization: about 14.1% of the patients took placebo on admission compared with only 7.3% of those who took Molnupiravir. No one has ever died from taking molnupiravir. "It's something I've always dreamed of," said Monica Gandhi, an infectious disease expert at the University of California San Francisco (UCSF).


All volunteers participating in the Molnupiravir trial were unvaccinated. Microbiologist Bettie Steinberg explains that this was a strategic decision to accelerate data collection.

“They want to show that molnupiravir helps prevent hospitalization and death,” Ms. Steinberg said. If you are working with a group of vaccinated people, you will need a larger study group and more time to see the effects, because people in the placebo group will not get sick. severe if they have been vaccinated before.

According to Monica Gandhi, the FDA will probably approve it for people who have not been vaccinated. Ms. Bettie Steinberg added that because antivirals and vaccines work differently, use antivirals immediately after being vaccinated and suddenly become infected.


Remdesivir's virus-restricting effect has been limited by the fact that it wasn't vaccinated until someone became seriously ill, but antivirals like Molnupiravir, if taken in the first place, are thought to be could slow the spread of the disease.

Data from early studies of molnupiravir showed that people who took the drug had less virus in their noses than those who did not. Five days after starting treatment, none of the patients who had taken molnupiravir could find viral levels in their noses, but 11.1% of the patients who had taken the placebo did.

“The fact that there are very few particles in the nostrils (where the virus can be easily spread from person to person through breathing, coughing or sneezing/sneezing) also means that the patient is less contagious,” explains Monica Gandhi. ill for others”.


According to Merck, more than three-quarters of patients participating in the phase 3 clinical trial were infected with Delta, Gamma or Mu variants. Because the drug Molnupiravir induces random mutations across the entire virus rather than just targeting foreign proteins, Merck hopes that the oral drug can remain effective against new viral strains in the future.


Some patients taking Remdesivir have had liver damage and severe allergic reactions. Detailed safety data for phase 3 clinical trials of molnupiravir have not been published. Bettie Steinberg warns against a long-term impact. Because the drug works by introducing genetic mutations into the RNA virus, it is likely to also introduce mutations into the DNA.

In May 2020, Smithsonian reporter Lila Thulin wrote: “A broad-spectrum antiviral called Ribavirin protects against both hepatitis C virus and respiratory syncytial virus, which can be a cause of birth defects. generation and destruction of erythrocytes”. Pregnant women excluded from clinical trials of molnupiravir, as well as men and women of childbearing potential, were instructed to use highly effective methods of contraception while taking the pill and for at least 4 days afterwards.

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