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How Does The New “COVID Pill” Work?

Doctorpedia Editorial Team Doctorpedia Editorial Team November 10, 2021
Medically reviewed by Susan Kerrigan, MD and Marianne Madsen

Merck has partnered with Ridgeback Biotherapeutics to produce a new antiviral drug known as  molnupiravir. The drug combats COVID to cut the risk of hospitalization. Of all the patients who took the drug during the trial phase, only 7.3% were hospitalized. From the patients who took the placebo (sugar pill) during testing, 14.1% were hospitalized and 8% did not survive. All patients who took molnupiravir survived.

 

Researchers ended the drug trial early because of the overwhelmingly positive response–they wanted everyone to have access to this drug. The drug is intended for use on patients with mild to moderate symptoms and is taken at home. It has not been tested on patients with more serious symptoms who have been hospitalized. This new drug is an exciting opportunity to treat patients conveniently before symptoms grow out of hand.

 

How does it work?

 

Viruses are very good at replicating themselves. They inject their genetic makeup into a healthy cell using strands of RNA (ribonucleic acid). When the virus’s RNA enters the cell, the cell creates copies of the virus instead of replicating itself. These new viruses will burst through the cell, destroy it, and move onto to reproduce in other body cells. However, when a COVID virus enters the body, molnupiravir will prevent it from replicating. As the virus makes a new strand of RNA, molnupiravir will infuse itself into the newly created RNA. Since molnupiravir’s structure is similar to the subunits, or nucleosides, that make up RNA and DNA (deoxyribonucleic acid), the virus doesn’t realize that an outside component is being introduced to its genetic material.

 

Molnupiravir produces so many mutations in the virus’s RNA that the new virus cells it helps create cannot function or reproduce. This prevents the COVID virus from growing and spreading throughout the body.

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What other antiviral options are available?

 

Until now, the main medical means to combat COVID has been through antibody therapies. Monoclonal antibody infusion treatment works by targeting the coronavirus’s “spike protein,” which is located on the outer shell. This spike protein allows the virus to inject its RNA into a body cell in order to reproduce. Monoclonal antibodies prevent the virus from being able to replicate long enough that the immune system can eliminate it.

 

Monoclonal antibodies ideally are administered in the early stages of COVID when symptoms just begin to manifest. When given to a patient in mild or moderate condition, antibodies reduced the likelihood of death or hospitalization significantly.  However, the antibodies must be administered through an IV, which requires an hour to administer in a hospital or clinic. The patient must also be monitored for another hour to make sure the treatment is working effectively.

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Why is Merck’s new drug more efficient?

 

Although molnupiravir is not the first COVID antiviral treatment, it is the first antiviral pill to prove competent against the virus. It halves the risk of hospitalization, is effective against the latest COVID strains, and has no serious side effects. The pill will be much cheaper and easier to distribute than other treatment options, and it can be stored and used without a freezer or expensive medical equipment.  This is especially convenient for low-income countries that may not have access to the necessary equipment to administer antibodies. 

 

When will it be available?

 

With all the excitement of a new drug to treat COVID from home, the world is wondering when it will be available for distribution. Merck requested emergency use authorization (EUA) from the United States Food and Drug Administration (FDA), and the FDA agreed to meet November 30 to discuss the request.

 

While awaiting approval from the FDA and other countries’ health bureaus, Merck is continuing to produce the pill and negotiate deals with world governments. Merck agreed to supply the U.S. Government with 1.7 million doses upon EUA or approval from the FDA.  The U.K. has also agreed to purchase 480,000 doses for late 2021. Merck announced that it will offer tiered pricing based on the country’s economic ability once it receives authorization within that country. To keep up with the demand, the company expects to produce 10 million courses of treatment by the end of 2021, with more to be available in 2022.

 

Do I still need to get the vaccine?

 

While both the COVID-19 vaccine and molnupiravir weaken the virus, each treatment does so in different ways. The purpose of the COVID vaccine is to prevent healthy individuals from catching and spreading the disease.The Moderna vaccine has a 96.3% chance of preventing COVID symptoms, while Pfizer’s vaccine is 95% effective for the immediate period after vaccination. In contrast, the molnupiravir pill has a 50% chance of preventing hospitalization once a patient has already begun manifesting symptoms. If you haven’t been fully vaccinated yet, it is important to make an appointment as soon as possible. Fighting the virus is much easier before it has a chance to take hold. Why wait until your body is already suffering, when you can stop this virus from ever provoking a sniffle?

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Merck’s molnupiravir pill is a huge step forward in the battle against COVID-19. Other companies such as Pfizer are also working toward producing additional antiviral drugs. With every new development, COVID treatments become better, cheaper, and more accessible. 

 

The horizon still holds many questions about the future of this pandemic. But with each medical advancement, we can also see a little bit of hope as well.

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