Is molnupiravir the breakthrough drug we’ve been waiting for?

We recently published an article looking at the new oral antiviral drug for Covid-19, molnupiravir, currently in its final stages of testing in humans. covid:aid followed up with the co-author, Professor Peter Barlow, Chair of Immunology and Infection at Edinburgh Napier University, to find out more about this promising Covid treatment.

What is molnupiravir and where did it come from?

Development of molnupiravir began in 2013 at Emory University in Atlanta, Georgia, with the aim to find a treatment for equine encephalitis virus infection – a mosquito-borne virus found among humans and animals in the Americas. Its success in preventing RNA viruses from spreading, including influenza, led developers Merck Sharp and Dohme (MSD) to apply for drug testing permissions in humans. They placed a subsequent request to test against Covid-19 when research revealed its potential as an effective treatment against SARS-CoV-2, the virus that causes Covid.

Clinical studies suggest that molnupiravir may prevent hospitalisation or death in patients with Covid-19 by as much as 50%.

Are there any known side effects?

Early studies into molnupiravir suggest headaches and diarrhea were common side effects. Though it’s important to note the diversity of participants in this trial was limited: most being healthy, Caucasian males. The next stage of clinical trials will evaluate the data on a broader scale, involving 1, 332 participants across 17 different countries. Researchers will be assessing the quality, safety and effectiveness of molnupiravir and examining whether early treatment can prevent the spread of Covid-19 within households containing one Covid-infected person.

What makes molnupiravir different from other Covid treatments?

Molnupiravir is a pill that can be taken orally. This means it could be self-administered in the early stages of infection. Covid vaccines or monoclonal antibody (mAbs) treatments on the other hand, like Ronapreve which was approved by the UK medicines regulator in August, must be injected or infused by a healthcare professional in hospitals or at a medical facility.

Additional benefits of molnupiravir are that it can be produced in large quantities at a low cost, and it does not require storage in below-freezing temperatures like the Pfizer BioNTech and Moderna vaccines. The drug therefore provides an affordable solution to the treatment of Covid-19 with a global accessibility range.

Vaccinations and oral treatments: why do we need both?

Many sceptics believe that vaccine booster jabs – now being offered to all adults over 50 following advice from the Joint Committee on Vaccination and Immunisation (JCVI) – and the development of drugs like molnupiravir, prove that Covid vaccines don’t work. The reality is that vaccine efficacy decreases over time which is why boosters and other forms of protection are necessary.

It’s critical to ensure that both therapeutic and preventative approaches for Covid-19 are used to the greatest effect.  Rapid and widespread vaccine deployment has already proven to be highly effective in reducing the likelihood of serious illness from the disease. The British Society for Immunology has prepared a free, detailed resource regarding the Covid-19 vaccine, prepared by experts, and I would encourage people to read this."  - Professor Barlow.

How soon could we see molnupiravir in circulation?

Experts predict this treatment will be approved by the UK’s medicines regulatory body – the Medicines and Healthcare products Regulatory Agency (MHRA) – by the end of this year. Professor Barlow said, “While the findings have yet to receive a full peer review, I’m hopeful that when the full data are released, there will be opportunities to utilise molnupiravir as a therapeutic approach to reduce the likelihood of patients becoming seriously ill with Covid-19, if treated in the early stages of the infection.”

In October, the UK government purchased 480, 000 courses of the drug with hopes that it will minimise the severity of Covid symptoms and “ease pressure on the NHS over winter”. This relies first on the treatment being approved; however the government and the NHS are already looking into how it can be effectively deployed across the country.

So, is this the breakthrough drug we’ve been waiting for?

The interim results from the molnupiravir phase 3 trial are encouraging, in so far as they indicate that oral treatment with the drug in the early stages of the infection could reduce the risk of hospitalisation or death for Covid-19 patients. These findings could represent a really encouraging step forward in terms of establishing effective, broad spectrum antiviral approaches for SARS-CoV-2." - Professor Barlow.

  • Thanks to Professor Peter Barlow for contributing to this article. Follow Peter on Twitter @ProfPeterBarlow

  • Photo by Adam Nieścioruk on Unsplash

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