COVID-19: Oral agent reduces risk of hospitalization and death
The active ingredient molnupiravir could reduce the risk of hospitalization and death in sick people by up to 50 percent. Molnupiravir interferes with the duplication of RNA viruses and can thus stop the virus from spreading in the body. The pill  is to be used in particular for outpatients with a short illness. The first studies give hope.
Molnupiravir – that’s behind the active ingredient against COVID-19
Molnupiravir (EIDD-2801) is a so-called prodrug of a known antiviral (N4-hydroxycytidine). Prodrugs are drugs that do not have any biological activity of their own. They are usually converted into active substances by chemical reactions in the human body.
N4-hydroxycytidine is incorporated into the RNA as the wrong building block and influences the structure and the copying process of the RNA. The mechanism of action is similar to that of the drug Remdesivir – the effect could be more pronounced and eliminate the virus in the body.
Originally, the effectiveness of the antiviral should be analyzed especially in connection with influenza viruses. Molnupiravir was developed to ensure improved oral availability. After the first studies on animals were particularly effective, a clinical study was planned.
In the context of the corona pandemic, however, molnupiravir has become the focus of COVID research. The active ingredient was initially tested on healthy volunteers in a phase 1 study. However, the study was criticized because previous animal experiments showed that related substances could be responsible for teratogenicity (malformations of the embryo and influence on fertility). The safety concerns have not been confirmed so far, and no serious side effects have occurred during phase 1.
Molnupiravir and COVID-19: studies show an effect
The relevant phase 3 study included a total of 775 COVID-19 patients with mild to moderate symptoms. All patients also had one of the following risk factors:
The patients received a five-day treatment with mulnopiravir or placebo  and had to take one tablet every twelve hours. In order to avoid teratogenic risks (malformations during pregnancy), male participants had to refrain from heterosexual contact and female participants had to prove that they used a reliable method of contraception  .
According to the first data from the pharmaceutical manufacturer Merck & Co., the interim analysis in August showed good results: The risk of hospitalization or death was reduced by 50 percent by the 29th day of infection. Serious side effects have not been registered to date.
The American Food and Drug Administration (FDA) insists  on rapid approval, and the USA wants to buy a total of 1.7 million doses of mulnopiravir. According to the manufacturer, contracts have already been concluded with governments worldwide.