A Promising New Covid Treatment

New Treatment

On September 28, Merck — A German multinational science and technology company — announced that it has created a pill to treat SARS-CoV-2 in partnership with Ridgeback Biotherapeutics. The drug in question is called molnupiravir, and while it was initially created to treat influenza, it has been in development as a broad-spectrum antiviral for about 10 years. Merck CEO Robert Davis stated that the company was “actively working with regulatory agencies around the world to submit applications for emergency use or marketing authorization in the coming months.”

Who will be able to access the pill?

This pill will be used to treat COVID-19-positive patients as soon as they begin showing symptoms. As is the case with most respiratory viruses, it is best to begin COVID-19 treatment early on. An initial lessening of the viral load reduces the risk of developing severe symptoms and lowers the likelihood of transmission.

Merck’s phase three clinical trial enrolled unvaccinated, high risk individuals. Initially, molnupiravir may only be available to this demographic, however it will likely become more widely available over time.

Merck intends to have this drug authorized in the US before the end of 2021. This appears to be a feasible objective considering that White House advisor on the health crisis, Anthony Fauci, called the data from the clinical trial “impressive.” Moreover, the U.S. government has preemptively ordered 1.7 million courses of treatment. Merck claims it will be able to produce enough pills for 10 million people by the end of this year.

Efficacy and Appeal

According to Merck, this drug reduces the risk of hospitalization or death due to COVID-19 by 50 percent. In the third phase of molnupiravir’s trial, a group of volunteers suffering early symptoms of COVID-19 were studied. Half of the volunteers were treated with molnupiravir while the other half received a placebo pill. Of the volunteers that received molnupiravir, only seven percent were hospitalized. In contrast, the group that received placebo pills displayed a hospitalization rate of 14 percent. One limitation of this drug trial was the relatively small sample group that was studied, which included only 775 at-risk patients.

Molnupiravir demonstrates lower efficacy than monoclonal antibodies; the intravenous cocktail that is currently used to treat high risk people with COVID-19. These antibodies can reduce hospitalizations and death by up to 85 percent. The appeal of the molnupiravir pill, however, is that it is far easier to administer and can reach a much larger population than the complex intravenous cocktail treatment. More importantly, the infusion treatment requires a hospital visit, thus demanding time and resources from medical professionals, and costs approximately 1,000 euros per injection.

Naomi Cailes, a registered nurse at the Peterborough regional health center, agreed that “the fact that [molnupiravir] is an oral pill is a huge advantage over current antivirals or monoclonal antibody infusions'' as these treatments are “invasive and depend on lots of resources.” Cailes, who has firsthand experience dealing with COVID patients, described the emotional toll of being a health care worker during the pandemic, citing the fact that there was “no time to grieve” after a patient died as there was always another patient requiring medical attention. As such, she expressed hope at the prospect of a drug which could reduce hospitalizations. However, as much as Cailes recognized the promise of monlupiravir, she was adamant that “vaccination should continue to be our first-line defense against COVID-19.”

Side Effects and Concerns

Molnupiravir is a mutagenic drug, thus it reduces viral load by forcing the COVID-19 virus to make mistakes while copying RNA. A Clinical Trials Arena article observed that there are “persistent side-effect concerns with mutagenic molnupiravir.”

In fact, Merck required male participants of their phase three trial to abstain from sex or use of contraception, and only included female participants who were not breastfeeding or pregnant, also requiring them to use a highly effective contraceptive or be abstinent during the study.

Merck virologist Daria Hazuda ensured that “no evidence of the potential for mutagenicity” has been observed in molnupiravir. According to an article published in Antimicrobial Agents and Chemotherapy, molnupiravir showed no serious adverse effects in its first-in-human phase one trial; fewer than half of the test subjects reported any effects, and of those that were reported, 93.3 percent were mild. It must also be noted that Molnupiravir is intended to be administered on a short term basis, which greatly reduces its risk of causing adverse effects.

Other Promising Treatments

The appeal of a simple, ingestible COVID-19 treatment is widely recognized in the pharmaceutical industry with both American Pfizer and Swiss Roche set to reveal the results of clinical trials for their own pills in the coming months.

Conclusion

Molnupiravir has the potential to greatly reduce the severity of COVID-19 symptoms, potentially preventing the need for hospitalization in many cases and thus opening up hospital beds for those who need them. From first hand sources, it is clear that high hospitalization rates are emotionally draining for patients and healthcare workers alike. This pill marks an important development in virus control and is likely also useful against influenza and ebola. It seems probable that this pill will soon be widely available, however it should not be treated as a replacement for vaccination, which remains the optimal defense against the spread of COVID-19.

- Saoirse Aherne