Why the COVID antiviral drug molnupiravir is sitting on pharmacy shelves: Shots

Merck’s antiviral drug molnupiravir is not popular with doctors who prefer to prescribe another antiviral, Paxlovid.

Merck & Co Inc.


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Merck & Co Inc.


Merck’s antiviral drug molnupiravir is not popular with doctors who prefer to prescribe another antiviral, Paxlovid.

Merck & Co Inc.

If you’ve just gotten sick with COVID-19 and are at high risk of serious illness, there are two types of pills — scattered around pharmacies across the United States — that could help prevent it from getting worse. But doctors say the two pills are not equal.

These antiviral pills – molnupiravir from Merck and Paxlovid from Pfizer – help prevent the virus from spreading throughout the body, when taken early in the illness. Both were cleared by the FDA in late December and are distributed by the US government.

But molnupiravir is a much less effective drug and many doctors are hesitant to prescribe it. “It’s an alternative rather than a first-line drug, and I think that’s why the use is lower,” says Dr. Rajesh Gandhi, from Mass General Hospital in Boston, who is helping to develop guidelines. of COVID-19 treatment for NIH and IDSA. , a medical company.

Both antivirals are five-day courses of pills that can only be prescribed to someone who tests positive for COVID and must be started within five days of the onset of symptoms.

Data reviewed by the FDA showed that molnupiravir was only 30% effective in reducing the risk of hospitalization with COVID-19. Paxlovid works much better, reducing the same risk by almost 90%. According to published data, infusion treatments with antibodies and antivirals also reduce the risk of severe disease more than molnupiravir. And molnupiravir carries reproductive risks, so it is generally not recommended for patients who are pregnant or trying to conceive.

On the shortlist of the first four COVID-19 treatments recommended by the government for patients before they need to be hospitalized, molnupiravir comes last – to be used only when other treatments cannot be used.

The federal government has spent $2.2 billion on molnupiravir – and many doses remain unused. Some pharmacies “are having inventory space issues on molnupiravir and not moving the product as quickly,” Dr. Derek Eisnor, who leads government distribution of COVID drugs, said recently during a call with officials. state health.

However, other more effective drugs also have their drawbacks. Paxlovid pills have a long list of common medications that you cannot take with them due to potentially dangerous interactions. Getting intravenous infusions of drugs – as patients do for the other two licensed treatments – requires visiting a clinic, sometimes multiple times. And many of these treatments are rare.

Gandhi therefore says that there is still a place for molnupiravir in the current COVID treatment landscape: as “an alternative when one of these other drugs cannot be administered, due to drug interactions or feasibility issues. “.

Trillium Health, a community health center in Rochester, NY, treats “a lot of complicated patients, who have complex medication lists, whose medications can’t always be stopped,” says co-founder and physician Dr. Bill Valenti. Staff.

The health center found a use for molnupiravir, prescribing it to more than a dozen patients, including Valenti’s 55-year-old patient John DeGrandis. “I’m a bit of his guinea pig sometimes,” jokes DeGrandis.

The first time DeGrandis had COVID was in the fall of 2020, before vaccines and treatments became available — and it felt like a really bad cold.

This month, when he got it back, there were medications licensed to treat mild COVID. “I think treating is better than not treating,” Valenti says, “So we went through the list.”

At the top of the list was Paxlovid – but Valenti ruled it out because it might have bad interactions with other drugs DeGrandis was taking.

Then there was a long waiting list for infusions, which could take a while. “It really wasn’t an option,” says Valenti, because the goal of early COVID treatments is to stop the virus from spreading throughout the body.

That left molnupiravir – which was plentiful at the local pharmacy and easy to take home. While it’s not as effective as the other options, “maybe we can balance that out by giving it to him early in his illness,” Valenti explained.

So DeGrandis filled her prescription at Walgreens and took four pills, twice a day, for five days. At the end of the course, did it help you? Not clear, says DeGrandis: “I don’t see the difference. Honestly, I haven’t felt bad all the time. I was a little tired, but now I feel 100 percent.”

Valenti says these COVID pills are the first generation of tools doctors can use to treat COVID patients early. “These drugs are good for the times, especially since it took so little time to find something useful. But I think this is just the beginning of the era of treatment,” he said.

Better drugs that take fewer pills and are more effective are being developed. For now, he will work with what he has.

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