New COVID Antiviral pill inspires hope

A new COVID-19 antiviral pill, known as molnupiravir, has shown promising results in early trials. Developed by Merck and Co., the drug has been found to reduce hospitalisation of patients with mild to moderate COVID-19 by 50%.

Merck are now applying for Emergency Use Authorisation, acting on advice by the US Food and Drugs Administration (FDA), and an independent Data Monitoring Committee.

What is molnupiravir?

Molnupiravir is a drug that slows the replication of SARS-CoV-2, the virus that causes the disease COVID-19. It is intended to reduce the risk of hospitalisation and death for patients who already have symptoms of coronavirus.

However, it is also currently being studied as the potential drug for post-exposure prophylaxis. This means it would be given to people who have had close contact with those infected with COVID-19. Studies are currently investigating as to whether it could prevent household transmission.

The drug was invented at Drug Innovations at Emory (DRIVE), LLC, a not-for-profit biotechnology company owned by Emory University. It was developed by Merck (also known as MSD), in collaboration with Ridgeback Biotherapeutics.

Why is the study so promising?

The study evaluated the data from 775 patients with laboratory-confirmed-COVID-19. All patients had at least one characteristic which increased their risk of COVID-19 making them severely unwell. This included obesity, diabetes and high blood pressure.

These patients were divided into two groups. The first group was treated with molnupiravir, and the second was given a placebo. This study produced three main encouraging findings:

1. The rate of hospitalisation was 50% lower for the group given molnupiravir. In addition, no deaths occurred amongst this group’s patients, compared to eight deaths in the placebo group.
2. Based on gene sequencing of 40% of participants, the pill was similarly efficient for the Gamma, Delta and Mu COVID-19 variants. These are currently the three most common COVID-19 variants worldwide.
3. Molnupiravir seems to induce few side effects. The incidence of drug induced ‘adverse events’ for patients treated with the pill was almost identical to those treated with a placebo.

How will the drug be made available?

Merck expects to produce 10 million courses of treatment by the end of 2021, and more in 2022. It has already agreed to supply approximately 1.7 million courses to the US government, at a cost of $1.2 billion – around £880 million – and is in early talks with other countries.

If approved, Merck claims that it will charge countries for their drug proportionally to their wealth. They have also entered into non-exclusive licencing agreements with established companies to improve availability in low and middle income countries.

What might the future hold?

Despite the new vaccines providing a very high rate of protection against COVID-19, breakthrough cases that require hospital treatment do occur. This means that the new antiviral drug could provide yet another layer to the safety net of societal protection.

Testing and widespread vaccination programmes help reduce the number of people being infected, but if you are infected, being vaccinated reduces your chance of becoming severely ill. If you are one of the small percentage of vaccinated people who would have still become severely ill, this new pill should reduce your chance of dying of COVID-19.

In addition, pills like these may help reduce the burden currently placed on hospitals. Wendy Holman, chief executive officer of Ridgeback Biotherapeutics, stated:

“With the virus continuing to circulate widely, and because therapeutic options currently available are infused and/or require access to a healthcare facility, antiviral treatments that can be taken at home to keep people with COVID-19 out of the hospital are critically needed”.

Wendy Holman

Combined with pre-existing tools, antiviral medications should help us move to a future where coronavirus has less of an impact on the world. In the UK, despite most people returning to daily life, about 800 people have died of COVID-19 in the last seven days.

Molnupiravir gives hope that as we ‘learn to live with COVID’, fewer people have to die from it.