How effective is the new “COVID pill” introduced to combat COVID-19? Very, according to the medical experts. So much so that if used properly, it could be a gamechanger in how we deal with the ongoing pandemic.
The pill, known as molnupiravir, named after Thor’s hammer, Mjölnir, could pack a superheroic knockout punch to the deadly virus. The oral antiviral was developed by Merck and Ridgeback Biotherapeutics. Last month, Merck and Ridgeback announced that molnupiravir could reduce by half the chances that a person infected by the coronavirus would need to be hospitalized.
Oral antivirals like molnupiravir could transform the treatment of covid-19 and of the pandemic more generally. Currently, treatments aimed at fighting covid—mainly monoclonal antibodies and antiviral drugs like remdesivir—are given through infusion or injection, usually in clinics or hospitals. By the time people manage to arrange a visit, they are often too sick to receive much benefit. Molnupiravir, however, is a little orange pill. If approved by the FDA, it will be the first antiviral that you could simply take at home like any other prescription medication.
With this drug available, a person might wake up, feel unwell, get a rapid covid test, and head to the pharmacy around the corner to pick up a pack. A full course, which needs to start within five days of the appearance of symptoms, consists of forty pills—four capsules taken twice a day, for five days.
Merck is now testing whether molnupiravir can prevent not just hospitalization after infection but also infection after exposure. If that’s the case, then the drug might be taken prophylactically—you could get a prescription when someone in your household tests positive, even if you haven’t.
On November 4, the U.K. became the first country to approve molnupiravir. On November 30, an FDA panel met to advise the agency on whether it should authorize emergency use for molnupiravir in the U.S.
The panel voted narrowly in favor of emergency use authorization for the antiviral pill. The vote was 13 for and 10 against authorization. The FDA isn’t obligated to follow the recommendations of its advisers but typically does.
If the agency authorizes the use of molnupiravir, it would be the first oral antiviral treatment for COVID-19 that could be taken at home.
A second oral medicine from Pfizer, called Paxlovid, is also being considered for authorization by the FDA.
Paxlovid was also staggeringly effective at preventing the progression of covid-19 in high-risk patients. The drug, when taken within three days of the onset of symptoms, reduced the risk of hospitalization by nearly ninety percent. Only three of the nearly four hundred people who took Paxlovid were hospitalized, and no one died; in the placebo group, there were twenty-seven hospitalizations and seven deaths. Paxlovid is administered along with another antiviral medication called ritonavir, which slows the rate at which the former drug is broken down by the body.
The reason that the FDA panel recommended the EUA for molnupiravir by only a four-vote margin is largely due to concern over the mutagenic properties of the drug. The way that it works to destroy COVID is by altering its RNA sequence, preventing it from replicating. However, that raises concerns if it could also mess with human DNA.
There is evidence that antiviral drugs can have a genetic impact on developing fetuses, so should the EUA be given, molnupiravir will likely not be recommended for pregnant women.
But with as we enter the winter months and the cold weather forces many Americans indoors, and with new variants such as Omicron already rearing their heads, these COVID pills could be the gamechanger that could prevent another winter surge.
Writing for the New Yorker, Dhruv Khullar, MD, a practicing physician and an assistant professor at Weill Cornell Medical College, said, “Outside of the vaccines, the new antiviral drugs are the most important pharmacologic advance of the pandemic. As the coronavirus becomes endemic, we’ll need additional tools to treat the inevitable infections that will continue to strike both vaccinated and unvaccinated people. These drugs will do that, reducing the damage that the coronavirus can inflict and, possibly, cordoning off avenues through which it can spread.”