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: The success of Merck's antiviral drug – and different COVID-19 capsules in improvement – could depend upon how rapidly individuals begin taking them

In the not too distant future, you may be able to walk into a doctor's office, get tested for SARS-CoV-2, and leave with pills or a prescription if you end up testing positive for the virus.

"Finally, we have another potential tool," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and senior medical advisor to President Joe Biden, at a briefing at the White House on October 6, entitled "A Promising New Oral Drug." that people could take home shortly after COVID-19 to reduce the risk of serious consequences. "

The drug is molnupiravir, which Merck & Co. Inc.
MRK,
-0.79%
and Ridgeback Biotherapeutics say it reduces the risk of hospitalizations and death by 50%. It is currently under review by the Food and Drug Administration and, if approved, will be the first oral antiviral to treat COVID-19 patients in the United States.

At least three more COVID-19 oral pills are expected to have clinical data by the end of the year, including drugs developed by Atea Pharmaceuticals Inc.
AVIR,
-3.00%
and Roche Holding AG
ROG,
+ 0.10%,
Fujifilm Holdings Corp. JP: 4901 (via a consortium of drug manufacturers including Appili Therapeutics Inc. APLIF and Dr. Reddy’s Laboratories Ltd.
RDY,
+ 1.16%
) and Pfizer Inc.
PFE,
+ 0.60%.

Shionogi & Co. Ltd.
4507,
+ 0.82%
also has an oral antiviral in a late clinical trial in Japan.

"Coronavirus disease will be with us for the foreseeable future, even if it becomes endemic," said Dr. Carl Dieffenbach, director of the AIDS division at NIAID and an official who leads the government's $ 3.2 billion COVID-19 antivirus program. "These pills could be incredibly valuable in putting down the bushfire."

It makes sense for drug companies to try to find out if antiviral drugs can reduce the risk of someone dying or suffering organ damage and expensive hospitalization.

They are also evaluating whether these pills can reduce viral loads, or how long a person who has contracted COVID-19 will be contagious or sick – or even prevent people from ending up with long-term COVID.

"If there is something that can effectively reduce viral load, it would reduce the risk of both severe symptoms and potentially long-term COVID symptoms in that person, and then of course reduce the risk of passing the virus on to others," said Dr. Carolyn Bramante, University of Minnesota Medical School pediatrician leading a clinical trial of reused drugs like ivermectin and metformin as a COVID-19 treatment.

If molnupiravir and other antiviral drugs are approved or approved, it matters how quickly they are prescribed, whether they are best prescribed after someone has been exposed to the virus or as soon as symptoms have been reported, and whether patients stop taking multiple pills in one day.

"The oral antivirals have to be taken early in the course of the disease because of their mode of action, certainly within five days," said Dr. Armand Balboni, CEO of Appili, who is working with Fujifilm on the development of the COVID-19 pill, Favipiravir. "I would argue that we will probably have to use it in three days, much like we use Tamiflu."

Roche's influenza drug Tamiflu, which can be used for treatment or post-exposure prophylaxis, must be taken within 48 hours of symptoms to be effective.

Experts often compare SARS-CoV-2 with HIV or influenza. Both are transmissible viruses and are best treated when an infected person has quick access to medical care. How these viruses respond to antiviral treatments can shed light on several factors, including when the virus is likely to become resistant to therapy and how quickly treatment should begin in COVID-19 patients.

“The aim is to get to a place as soon as possible after diagnosis where people who have been diagnosed with coronavirus can start medication,” said Dieffenbach. “If it's built logically and systematically, you can either take pills or a prescription for the drug with you at the time of the test. With HIV we call it test-and-treat. "

But that can be difficult for the already disconnected healthcare system in the US. Ensuring that people are immediately tested even after possible exposure to COVID-19 is a challenge. Making sure they get a prescription and take several pills a day could be another obstacle.

For example, patients in the Merck study took four tablets twice a day for five days, while Fujifilm's favipiravir tested 90 tablets in 10 days. Pfizer's experimental antiviral requires two tablets per day for five days.

For people with mild to moderate COVID-19 cases, however, only monoclonal antibodies are available that must be administered in a doctor's office and are only intended for people with a severe risk of disease. “You will be given an infusion,” said Dieffenbach. "It's not a trivial thing."

Because the monoclonal antibodies have not always been readily available, this has hindered their use, especially among people in rural America who live tens or even hundreds of kilometers from the nearest hospital or clinic.

“We need this because we need a tool kit,” said Balboni. “The toolbox is absolutely vaccines. But it also includes monoclonal antibodies. It includes broad-spectrum oral antivirals and likely stacking the broad-spectrum oral antivirals to make sure we don't develop resistance. "

Read more about MarketWatch's coverage of COVID-19 antiviral drugs:

Why a pill you take at home could change the direction of the pandemic

This development could fully reopen the world economy – and the stock market has largely ignored it

“It's not a magic pill”: what Merck's antiviral pill could mean for vaccination hesitation

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