The Times Australia
The Times World News

.
The Times Real Estate

.

Could oral antiviral pills be a game-changer for COVID-19? An infectious disease physician explains why these options are badly needed

  • Written by Patrick Jackson, Assistant Professor of Infectious Diseases, University of Virginia
Could oral antiviral pills be a game-changer for COVID-19? An infectious disease physician explains why these options are badly needed

Nearly two years into the pandemic, it has become starkly clear that we need better treatments for COVID-19 for people in the earlier stages of disease.

Two new antiviral drugs could soon be the first effective oral treatments for COVID-19 to help keep people out of the hospital. An advisory committee to the Food and Drug Administration plans to review the data supporting molnupiravir[1] – a pill made by Merck and partner Ridgeback Therapeutics – on Nov. 30, 2021.

And in early November, Pfizer released preliminary results for its antiviral pill[2], Paxlovid, another potentially promising tool for COVID-19 treatment[3]. On Nov. 16, Pfizer formally requested emergency use authorization[4] of the oral pill from the FDA.

If these drugs get authorized in the coming weeks, they could be an important new treatment option for people with COVID-19, especially for those at high risk in the early stages of infection. The ability to treat COVID-19 with a pill rather than an injection or infusion means more people can be treated faster.

As an infectious diseases physician[5] and scientist[6] at the University of Virginia, I have helped care for hundreds of people with COVID-19. I’ve also helped conduct clinical trials to find new treatments. Molnupiravir and Paxlovid would fill a need that hasn’t been met by other COVID-19 drugs, which are either difficult to administer or only suitable for patients in the hospital.

Here’s a preview of why these new antiviral drugs are important, how they work and how they could be used.

Filling a gap in treatment

Researchers have so far found just a few drugs[7] that are effective for the treatment of COVID-19. Until now, only antiviral monoclonal antibodies[8] could be used to treat patients who are not hospitalized. However, these antibody drugs – which work by blocking the virus from entering cells – have to be given in a monitored setting like a doctor’s office.

And many patients who could benefit from monoclonal antibodies don’t have access[9] because administration sites aren’t located nearby. They are also not affordable for many people outside the U.S.[10] In the U.S., monoclonal antibodies are free to patients under emergency use authorization but could ultimately become far more expensive if and when they receive full approval by the FDA.

Early data suggests that both molnupiravir[11] and Paxlovid[12] are effective new drugs that patients can take at home to prevent complications of COVID-19 – which could be particularly beneficial for those at high risk of severe disease. Once authorized, these pills will allow patients to be treated earlier in the course of infection, at the point when antiviral drugs are more effective. By stopping the virus from growing in the body early on, the drugs can prevent the inflammation that causes severe COVID-19.

A young man in a mask receives a COVID-19 vaccination shot.
Although oral antiviral pills could be a major step forward in treating COVID-19, vaccines still offer the best protection from the virus. Prostock-Studio/iStock via Getty Images Plus[13]

How molnupiravir and Paxlovid work

Molnupiravir works by causing the virus to record inaccurate genetic information[14]. SARS-CoV-2 stores its instructions for making new viruses in a strand of RNA. Inside the cell, the virus makes copies of the RNA and then continues to make duplicates of those copies. When a patient takes molnupiravir, the drug masquerades as one of the key molecules in RNA and gets incorporated into the strands that the virus produces. When an RNA strand containing molnupiravir gets copied in turn, the virus makes errors in the copy. Over multiple rounds of copying, molnupiravir forces more and more mistakes until the virus is no longer able to function – a phenomenon in virology called “error catastrophe[15].”

Paxlovid uses a different mechanism to prevent the virus from replicating. SARS-CoV-2 creates proteins[16] that are needed to build new viruses as one long string, called a polyprotein. But the polyproteins have to be chopped into smaller parts by a viral enzyme called a protease[17] in order to become active. Paxlovid blocks the virus’s protease[18] from doing this job, thereby preventing the virus from completing its life cycle.

How COVID-19 pills would be used

There are currently two primary forms of treatment for COVID-19 in the U.S.: antiviral and anti-inflammatory medications. Antiviral drugs stop the virus from growing in the body and are given within the first few days of symptoms to prevent severe disease. Anti-inflammatory drugs moderate the immune response and are used to help sicker patients who need oxygen.

Molnupiravir[19] and Paxlovid[20] were studied in separate clinical trials with similar designs. In both studies, the drugs were tested in outpatients with risk factors for severe COVID-19 who were at an early stage in their illness. Both studies also looked at how likely patients were to either die or be hospitalized. However, neither study has yet been peer-reviewed.

Molnupiravir reduced the risk of death or hospitalization by about 50% in non-hospitalized adult patients with mild to moderate COVID-19 when treated within five days of symptom onset. Paxlovid reduced this risk by about 89% for patients treated within three days of symptoms and 85% for patients treated within five days. Importantly, no patients who took either drug died in the studies. Because the drugs were not studied head to head, it’s difficult to say whether one will be better than the other in the real world. In early November, Britain became the first country to approve molnupiravir[21] for use.

Molnupiravir did not help hospitalized patients[22] recover faster from COVID-19. It is likely that Paxlovid would also not be useful at the point of hospitalization. Most patients who are in the hospital with COVID-19 are sick because of unregulated inflammation and not because the virus is still replicating in their bodies.

If and when these drugs get authorized in the U.S., they will probably be used for the same higher-risk patients who are eligible for monoclonal antibodies today. Monoclonal antibodies may still be used, though, for pregnant people, people on dialysis and some immune-compromised patients.

The U.S. has already purchased millions of doses of both molnupiravir[23] and Paxlovid[24] in anticipation of their authorization. However, the pills will only be useful if people also have access to cheap, fast and accurate COVID-19 tests, which are currently in short supply[25]. If COVID-19 is diagnosed too late, patients will already be outside the window of time when antiviral drugs can be helpful.

[More than 140,000 readers get one of The Conversation’s informative newsletters. Join the list today[26].]

Other antiviral drugs are in development, including an oral form of the first COVID-19 drug, remdesivir[27] and long acting injectable monoclonal antibodies[28].

Researchers are also working on repurposing existing drugs to treat COVID. Inhaled steroids like budesonide[29] and an antidepressant called fluvoxamine[30] are particularly promising.

While it’s exciting to see new treatments for COVID-19, prevention is still the best strategy. The COVID-19 vaccines continue to be the most effective tool for helping to end the pandemic.

[Understand new developments in science, health and technology, each week. Subscribe to The Conversation’s science newsletter[31].]

References

  1. ^ review the data supporting molnupiravir (www.fda.gov)
  2. ^ preliminary results for its antiviral pill (www.pfizer.com)
  3. ^ another potentially promising tool for COVID-19 treatment (www.statnews.com)
  4. ^ Pfizer formally requested emergency use authorization (www.statnews.com)
  5. ^ infectious diseases physician (uvahealth.com)
  6. ^ and scientist (scholar.google.com)
  7. ^ just a few drugs (theconversation.com)
  8. ^ antiviral monoclonal antibodies (www.covid19treatmentguidelines.nih.gov)
  9. ^ don’t have access (www.washingtonpost.com)
  10. ^ outside the U.S. (www.who.int)
  11. ^ molnupiravir (www.merck.com)
  12. ^ Paxlovid (www.pfizer.com)
  13. ^ Prostock-Studio/iStock via Getty Images Plus (www.gettyimages.com)
  14. ^ inaccurate genetic information (doi.org)
  15. ^ error catastrophe (doi.org)
  16. ^ SARS-CoV-2 creates proteins (doi.org)
  17. ^ a viral enzyme called a protease (doi.org)
  18. ^ blocks the virus’s protease (doi.org)
  19. ^ Molnupiravir (www.merck.com)
  20. ^ Paxlovid (www.pfizer.com)
  21. ^ Britain became the first country to approve molnupiravir (www.gov.uk)
  22. ^ hospitalized patients (www.merck.com)
  23. ^ molnupiravir (www.merck.com)
  24. ^ Paxlovid (www.reuters.com)
  25. ^ currently in short supply (www.propublica.org)
  26. ^ Join the list today (memberservices.theconversation.com)
  27. ^ first COVID-19 drug, remdesivir (doi.org)
  28. ^ injectable monoclonal antibodies (www.astrazeneca.com)
  29. ^ like budesonide (doi.org)
  30. ^ antidepressant called fluvoxamine (doi.org)
  31. ^ Subscribe to The Conversation’s science newsletter (theconversation.com)

Read more https://theconversation.com/could-oral-antiviral-pills-be-a-game-changer-for-covid-19-an-infectious-disease-physician-explains-why-these-options-are-badly-needed-169919

The Times Features

Best Deals on Home Furniture Online

Key Highlights Discover the best deals on high-quality outdoor furniture online. Transform your outdoor space into a stylish and comfortable oasis. Explore a wide range of d...

Discover the Best Women's Jumpers for Every Season

Key Highlights Explore lightweight jumpers for spring and summer, ensuring breathability and ease. Wrap up warm with cozy wool jumpers for the chilly autumn and winter season...

Uncover the Elegance of Gorgeous Diamond Tennis Necklaces

Key Highlights Diamond tennis necklaces are a timeless piece of jewelry that exudes elegance and sophistication. They feature a continuous line of brilliant-cut diamonds, cre...

Dental Implants vs. Dentures: Which Is Better for You?

When it comes to replacing missing teeth, two of the most common options are dental implants and dentures. Both have their advantages and disadvantages, so choosing between them ...

What Neck Pain Really Means (And Why It’s More Than Just Poor Posture)

Neck pain is often brushed off as something temporary — a tight spot after a long day at the desk or a poor night’s sleep. But when the discomfort keeps returning, it could be a ...

The Work of Gosha Rubchinskiy: Fashion, Culture, and Youth

From Designer to Cultural Architect Gosha Rubchinskiy is not just a fashion designer—he's a cultural force. Born in Moscow in 1984, Rubchinskiy began his career in fashion in t...

Times Magazine

The Essential Guide to Transforming Office Spaces for Maximum Efficiency

Why Office Fitouts MatterA well-designed office can make all the difference in productivity, employee satisfaction, and client impressions. Businesses of all sizes are investing in updated office spaces to create environments that foster collaborat...

The A/B Testing Revolution: How AI Optimized Landing Pages Without Human Input

A/B testing was always integral to the web-based marketing world. Was there a button that converted better? Marketing could pit one against the other and see which option worked better. This was always through human observation, and over time, as d...

Using Countdown Timers in Email: Do They Really Increase Conversions?

In a world that's always on, where marketers are attempting to entice a subscriber and get them to convert on the same screen with one email, the power of urgency is sometimes the essential element needed. One of the most popular ways to create urg...

Types of Software Consultants

In today's technology-driven world, businesses often seek the expertise of software consultants to navigate complex software needs. There are several types of software consultants, including solution architects, project managers, and user experienc...

CWU Assistive Tech Hub is Changing Lives: Win a Free Rollator Walker This Easter!

🌟 Mobility. Independence. Community. All in One. This Easter, the CWU Assistive Tech Hub is pleased to support the Banyule community by giving away a rollator walker. The giveaway will take place during the Macleod Village Easter Egg Hunt & Ma...

"Eternal Nurture" by Cara Barilla: A Timeless Collection of Wisdom and Healing

Renowned Sydney-born author and educator Cara Barilla has released her latest book, Eternal Nurture, a profound collection of inspirational quotes designed to support mindfulness, emotional healing, and personal growth. With a deep commitment to ...

LayBy Shopping