In the Atlantic, Dr. Monica Gandhi writes about The New COVID Drugs
Although molnupiravir—which is named after the Norse god Thor’s hammer, Mjölnir—was being tested for the treatment of the Ebola virus, researchers had not settled upon a purpose for the drug before SARS-CoV-2 arrived on the scene. Early studies of molnupiravir showed that its recipients cleared the coronavirus more rapidly than recipients of a placebo did. The drug did not help patients who were already hospitalized, but in outpatients with mild to moderate disease who had a high vulnerability to severe disease, it reduced the risk of hospitalization or death by 30 percent if given within five days of developing symptoms. The drug proved so beneficial that the clinical study was called off early. Merck applied for emergency-use authorization, and the FDA is expected to review the drug this week. Merck has promised to share its technology with the Medicines Patent Pool (MPP), which will allow for more affordable global access to molnupiravir.
Paxlovid, a formula developed largely from scratch for the current pandemic, is actually an RNA-virus protease inhibitor called PF-07321332 “boosted” with another drug called ritonavir. It too was the subject of a clinical trial that was stopped early because the treatment looked so effective. Outpatients who had both COVID-19 and medical conditions that put them at high risk of severe illness were 89 percent less likely to be hospitalized if they received Paxlovid twice daily for five days than if they got a placebo. The FDA will likely review this important therapeutic before the end of the year. The U.S. government has bought millions of courses of molnupiravir and Paxlovid for Americans in anticipation of the authorization of both. Moreover, Pfizer has promised to accelerate worldwide access to Paxlovid through an agreement with MPP.
After all that, this article in the New York Times – As Antiviral Pills Arrive, Can Testing Keep Up? (paywall) asks a good question, these treatments only work if you KNOW you have COVID and testing is still “shaky” at best in the USA.
But the pills, which interfere with viral replication, are designed to be taken as soon as possible after symptoms appear. Fully harnessing their benefits is likely to depend upon timely, accurate Covid testing — something that the United States has struggled to achieve since the beginning of the pandemic.
… (the) supply of the new drugs is likely to be extremely limited initially. Merck, for instance, is expected to supply enough of its drug to treat slightly more than 3 million Americans before February.
Still, the new antivirals could put America’s still shaky testing infrastructure to the test, experts said. And officials will need to ensure that quick, affordable virus tests are available in the communities that have been especially hard hit by Covid.
12/02/21 – Science News has this article today:
Merck’s COVID-19 pill may soon be here. How well will it work?
New data have revealed uncertainty about the drug’s efficacy and who should use it
Hopes for an easy pill that could combat COVID-19 before people land in the hospital have dimmed a bit. New data about an antiviral pill made by Merck with its partner Ridgeback Pharmaceuticals show it’s not as stellar as first believed. And the drug has drawbacks that could outweigh its potential to fight the coronavirus and keep people out of the hospital.
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And a few days ago in Ars Technica: Efficacy of Merck’s Thor-inspired COVID pill crumbles