Two new oral treatments for Covid-19 offer hope


Compared to current hospital-based treatments, a course of pills for Covid-19 means that the disease can be managed at home. — dpa

Just two years shy of the first reported outbreak of Covid-19 in Wuhan, China, comes the good news that two reportedly effective oral drugs are likely to be available soon to treat this infectious disease.

The latest news that American pharmaceutical company Pfizer has successfully developed an antiviral pill against Covid-19 is indeed exciting and should reduce global fear of the pandemic.

At the time of writing, the official Covid-19 count is over 250 million cases and five million deaths worldwide.

According to a press release by Pfizer, its experimental pill, currently called PF-07321332, has been shown to reduce hospitalisation or death for adults at risk of severe disease by 89%.

The clinical trial using this drug was stopped prematurely on the recommendation of an independent group of medical experts monitoring the trial because the interim results showed overwhelming efficacy and clear benefit.

The company plans to submit the findings to US regulatory authorities for emergency authorisation before Nov 25 (2021).

In the clinical trial for this drug, which involved 1,219 elderly adults who were unvaccinated or had an underlying health condition that placed them at high risk of serious illness from Covid-19, only 0.8% of people on a five-day treatment regime became sick and ended up in hospital, and no one died.

In the placebo group, 7% of people ended up in hospital or died within five days of their symptoms appearing.

Pfizer did not provide details on side effects, but stated that the problems were mild and similar in the two groups at about 20%.

The result of the clinical trial, which has yet to be published, is highly significant statistically and has important global implications as it has the potential to save patients’ lives, reduce the severity of Covid-19 infections, and eliminate nine out of 10 hospitalisations.

Already approved

News of Pfizer’s pill comes soon after the approval of another American pharmaceutical company Merck’s antiviral drug, molnupiravir, which has already been approved for use in the United Kingdom.

Malaysia has also placed an order for 150,000 courses of molnupiravir at the reported cost of RM420 million.

Molnupiravir is an antiviral medication working at the RNA (ribonucleic acid) polymerase gene level to prevent virus replication by introducing errors into the genetic code of the virus.

On the other hand, PF-07321332, which is a protease inhibitor, works to block a crucial enzyme that the SARS-CoV-2 virus needs in order to replicate.

Both drugs are taken orally, twice a day for five days.

Molnupiravir showed a 50% reduction in hospitalisation or death in a trial involving 385 patients and 377 controls who got a placebo.

This trial was also stopped early because the results were so encouraging, showing that it can work against the most common SARS-CoV-2 viral variants, including Delta and Gamma.

Cost and production

Presently, the current Covid-19 treatments using remdesivir and monoclonal antibody therapy require a hospital stay as they are given by intravenous (IV) infusion or injection.

There is an urgent need to find a simpler treatment regime where medication can be taken at home to ease symptoms, speed recovery and keep people out of hospitals.

Although these antiviral drugs are expected to be made available soon, the cost may be so prohibitive that it will be the deciding factor in its use globally.

Merck’s US contract price is around USD700 (RM2,906.40) for a five-day course of molnupiravir.

We do not yet know how much the cost for a five-day course of PF-07321332 will be.

Pfizer is in active discussions with 90 countries, stating that its price will be close to that of Merck’s, but will consider several lower pricing options for low- income countries.

Production to meet the global demand will also be challenging.

Merck expects to produce 10 million courses by the end of the year, and has announced voluntary licensing agreements with generic drug manufacturers in India to accelerate molnupiravir’s availability to low- and middle-income countries.

As for Pfizer, it is targeting to produce more than 180,000 packs of their drug by the end of this year, with a projected production of 50 million packs by the end of 2022.

As with all antiviral drugs, both pills must be given as early as possible to maximise their effectiveness.

Pfizer’s pill is given in combination with an older antiretroviral drug called ritonavir.

Ritonavir was previously used to treat HIV, but is now used in lower doses to help boost the levels of other HIV (human immunodeficiency virus) medications.

Further trials are still in progress to determine whether PF-07321332 will prevent infection in all age groups, including young children, and to prove that the success of these pills in clinical trials can be repeated in the real world.

Vaccination still necessary

Could these pills replace the need for vaccines?

The answer is no.

Vaccination is still the most effective protection against Covid-19.

These oral medications will help in reducing the risk of severe disease, hospitalisation and death, leading to huge savings.

But it still does not prevent infection.

The vaccine rollout of more than seven billion doses globally has only covered half the world’s population, and many have been reluctant to be vaccinated.

Hopefully, more people will agree to be vaccinated and accept the third dose for better protection.

We must continue to practice social and public health measures such as the wearing of face masks, maintaining physical distancing, and regular handwashing, until we reach the stage where over 80% of our total population, including children, are vaccinated.

Developing effective antiviral drugs is extremely difficult, requires huge budgets and often takes many years.

We now have not one, but two potentially useful antiviral pills developed within two years against Covid-19, which should prove to be significant game changers in treating the SARS-CoV-2 virus.

This, plus the vaccine rollout and maintenance of public health measures, make Covid-19 a less daunting and fearful disease, and holds up hope that the pandemic will soon be over!

Emeritus Professor Datuk Dr Lam Sai Kit is a virologist, Universiti Malaya research consultant and Academy of Sciences Malaysia senior fellow. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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