Molnupiravir and Nirmatrelvir/Ritonavir: The New Available Antiviral Options for COVID-19

Authors

  • Samuel Theodorus Sutanto Faculty of Medicine, Universitas Kristen Krida Wacana, Jakarta, Indonesia
  • Robert Sinto Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
  • Adeline Pasaribu Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
  • Sharifah Shakinah Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Keywords:

antiviral, COVID-19, molnupiravir, nirmatrelvir/ritonavir, SARS-CoV-2

Abstract

Coronavirus disease 2019 (COVID-19) is a respiratory tract disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). With the complexity of multimorbidity in Indonesia, it is crucial to find another line of antiviral for COVID-19. This article aims to review two antivirals, molnupiravir and nirmatrelvir/ritonavir, that have been studied extensively in treating COVID-19 with promising results, and their availability in Indonesia. Molnupiravir and nirmatrelvir/ritonavir are two of many repurposed drugs in clinical trials, which have been reported to have a mechanism in quick clearance of SARS-CoV-2, reduction in viral load, and fast symptoms recovery time in phase 1 and 2 clinical trials. Phase 2/3 clinical study in COVID-19 patients without any indication for hospitalization showed that molnupiravir and nirmatrelvir/ritonavir significantly reduced the risk of hospitalization and death.

References

John Hopkins Univeristy. COVID-19 Dashboard by the Center for Systems and Engineering at Johns Hopkins University. Published 2022. Accessed September 21, 2022. https://www.coronavirus.jhu.edu/map.html

Kementerian Kesehatan Republik Indonesia. Situasi Terkini Perkembangan Coronavirus Disease (COVID-19). Published 2022. Accessed September 21, 2022. https://infeksiemerging.kemkes.go.id/situasi-infeksi-emerging/situasi-terkini-perkembangan-coronavirus-disease-covid-19-08-agustus-2022

Kementerian Kesehatan Republik Indonesia. Vaksinasi COVID-19 Nasional. Published 2022. Accessed September 21, 2022. https://vaksin.kemkes.go.id/#/vaccines

Drozdzal S, Rosik J, Lechowicz K, et al. An update on drugs with therapeutic potential for SARS-CoV-2 (COVID-19) treatment. Drug Resist Updat. 2021;59:1-27. doi:doi.org/10.1016/j.drup.2021.100794

Hashemian SMR, Pourhanifeh MH, Hamblin MR, Shahrzad MK, Mirzaei H. RdRp inhibitors and COVID-19: Is molnupiravir a good option? Biomed Pharmacother. 2022;146(January). doi:doi.org/10.1016/j.biopha.2021.112517

Şimşek-Yavuz S, Komsuoğlu Çelikyurt FI. An update of anti-viral treatment of COVID-19. Turkish J Med Sci. 2021;51(SI1):3372-3390. doi:10.3906/sag-2106-250

Hung YP, Lee JC, Chiu CW, et al. Oral Nirmatrelvir/Ritonavir therapy for COVID-19: The dawn in the dark? Antibiotics. 2022;11(2):5-11. doi:10.3390/antibiotics11020220

Imran M, Arora MK, Mohammed S, et al. Discovery, development, and patent trends on Molnupiravir: A prospective oral treatment for COVID-19. Molecules. 2021;26:5795.

Fischer W, Eron JJ, Holman W, et al. Molnupiravir, an oral antiviral treatment for COVID-19. medRxiv Prepr Serv Heal Sci. 2021:1-30. doi:10.1101/2021.06.17.21258639

Fischer WA, Eron JJ, Holman W, et al. A phase 2a clinical trial of molnupiravir in patients with COVID-19 shows accelerated SARS-CoV-2 RNA clearance and elimination of infectious virus. Sci Transl Med. 2022;14(628):1-11. doi:10.1126/scitranslmed.abl7430

Pourkarim F, Pourtaghi-Anvarian S, Rezaee H. Molnupiravir: A new candidate for COVID-19 treatment. Pharmacol Res Perspect. 2022;10(1):1-7. doi:10.1002/prp2.909

Singh AK, Singh A, Singh R, Misra A. Molnupiravir in COVID-19: A systematic review of literature. Diabetes Metab Syndr Clin Res Rev. 2021;15(6):102329. doi:10.1016/j.dsx.2021.102329

National Institutes of Health. Molnupiravir. NIH. Published 2022. Accessed June 4, 2022. https://www.covid19treatmentguidelines.nih.gov/therapies/antiviral-therapy/molnupiravir/#:~:text=In nonhospitalized patients aged ≥,(Paxlovid)%2C sotrovimab%2C or

Burhan E, Susanto AD, Nasution SA, et al. Pedoman Tatalaksana COVID-19. PDPI PERKI PAPDI PERDATIN IDAI; 2022.

Thorlund K, Sheldrick K, Meyerowitz-Katz G, Singh S, Hill A. Making statistical sense of the Molnupiravir MOVe-OUT clinical trial. Am J Trop Med Hyg. 2022;106(5):1301-4. doi:10.4269/ajtmh.21-1339

Jayk Bernal A, Gomes da Silva MM, Musungaie DB, et al. Molnupiravir for oral treatment of COVID-19 in nonhospitalized patients. N Engl J Med. 2022;386(6):509-520. doi:10.1056/nejmoa2116044

Hammond J, Leister-Tebbe H, Gardner A, et al. Oral Nirmatrelvir for high-risk, Nonhospitalized adults with COVID-19. N Engl J Med. 2022;386(15):1397-408. doi:10.1056/nejmoa2118542

McDonald EG, Lee TC. Nirmatrelvir-ritonavir for COVID-19. CMAJ. 2022;194(6):218. doi:10.1503/cmaj.220081

National Institutes of Health. Ritonavir-boosted Nirmatrelvir (Paxlovid). NIH. Published 2022. Accessed June 4, 2022. https://www.covid19treatmentguidelines.nih.gov/therapies/antiviral-therapy/ritonavir-boosted-nirmatrelvir--paxlovid-/

Lai CC, Wang YH, Chen KH, Chen CH, Wang CY. The clinical efficacy and safety of anti-viral agents for non-hospitalized patients with COVID-19: A systematic review and network meta-analysis of randomized controlled trials. Viruses. 2022;14(8):1-10. doi:10.3390/v14081706

Singh AK, Singh A, Singh R, Misra A. An updated practical guideline on use of molnupiravir and comparison with agents having emergency use authorization for treatment of COVID-19. Diabetes Metab Syndr Clin Res Rev. 2022;16(January):1-10. doi:doi.org/10.1016/j.dsx.2022.102396

Toussi SS, Neutel JM, Navarro J, et al. Pharmacokinetics of oral Nirmatrelvir/Ritonavir, a protease inhibitor for treatment of COVID-19, in subjects with renal impairment. Clin Pharmacol Ther. 2022;0(0):1-9. doi:10.1002/cpt.2688

POM B. SIARAN PERS Badan POM terbitkan emergency use authorization untuk obat Molnupiravir. Published 2022. Accessed June 2, 2022. https://www.pom.go.id/new/view/more/pers/636/SIARAN-PERS-Badan-POM-Terbitkan-Emergency-Use-Authorization-untuk-Obat-Molnupiravir.html

Kompas.com. Mengenal Molnupiravir dan Paxlovid, obat COVID-19 yang digunakan di Indonesia. Published 2022. Accessed June 2, 2022. https://www.kompas.com/sains/read/2022/01/13/193000823/mengenal-molnupiravir-dan-paxlovid-obat-covid-19-yang-digunakan-di?page=all

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Published

2023-01-10

How to Cite

Sutanto, S. T., Sinto, R., Pasaribu, A., & Shakinah, S. (2023). Molnupiravir and Nirmatrelvir/Ritonavir: The New Available Antiviral Options for COVID-19. Acta Medica Indonesiana, 54(4), 638. Retrieved from https://actamedindones.org/index.php/ijim/article/view/2115