Merck Sharp & Dohmes (MSD) molnupiravir, received FDA authorisation on Dec 23, on the grounds of the results of a phase 3 study including 1433 patients with mild-to-moderate COVID-19 with at least one risk factor for severe illness, where treatment with molnupiravir within 3 days of symptom onset showed reduced the chances of hospitalization or death by 30%.

MSD has struck an agreement with the Medicines Patent Pool (MPP) allowing dozens of low-and-middle-income countries around the world to access molnupiravir. It has also signed licensing agreements with several generics manufacturers. 

The oral antivirals escape the complications of the monoclonal antibodies and are a lot less expensive, thus are very well suited to low-and-middle-income countries.

As Molnupiravir is simple to manufacture, and thus is likely to be the most widely available antiviral for COVID-19. Molnupiravir evokes an assemblage of errors in the replicating virus until the virus can no longer survive. 

Indian pharmaceutical firm Dr Reddys Laboratories has announced that it would sell a course of its version of molnupiravir for 1400 rupees.

There remain concerns that molnupiravir could potentially affect bone and cartilage growth; thus FDA does not approve its use in people under the age of 18 years.

The PANORAMIC trial is the most awaited study as it will explore the effectiveness of several COVID-19 antivirals in high-risk patient populations in the UK, where a majority of participants are likely to be vaccinated. A substudy within the trial will also examine the ability of antivirals to prevent transmission of SARS-CoV-2. 

Source- Respiratory Medicine; 2022 January 13. DOI:https://doi.org/10.1016/S2213-2600(22)00011-X