Antivirals in the fight against COVID-19, by Elmer Huerta

Unlike the fight against bacteria – against which multiple antibiotics have been developed – science has not known, or has not been able (with notable exceptions that we will see in a moment) to develop antiviral drugs that help cure or prevent diseases caused by virus. The announcement of October 1 – which if proven would be the first oral antiviral drug against new coronavirus– gives us the opportunity to review this important field of medicine.

Difference between virus and bacteria

Undoubtedly one of the topics of basic scientific knowledge that the pandemic, is that Viruses are not living beings, because they are not born, they do not grow or die, they only reproduce. Bacteria on the other hand, if they are living beings, so they are born, grow, reproduce and die.

That is why antibiotics, by interfering with the biological functions of the living being, only act against bacteria, and their development has been considered one of the greatest advances in medicine. However, despite the existence of dozens of infections caused by viruses, the same progress has not been made with the discovery of antivirals.

The exceptions

In recent years, antivirals have been developed that have managed to affect the natural history of such important diseases as infection with the human immunodeficiency virus HIV and hepatitis C.

These advances have achieved that currently, people infected with HIV and who start and comply with their treatment regimen with antiretroviral drugs, have -although with some lower quality– a life expectancy similar to that of an uninfected person. , those that include nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), fusion inhibitors, CCR5 antagonists, post-binding inhibitors, and strand transfer inhibitors integrasa (INSTI).

Another disease that is treated with antiviral drugs is hepatitis C, which until a few years ago, was unfailingly fatal. At present there are direct-acting antivirals (DAAs), that . Some of those drugs, used alone or in combination, include simeprevir, sofosbuvir, ledipasvir, ombitasvir, paritaprevir, ritonavir, dasabuvir, velpatasvir, voxilaprevir, glecaprevir, pibrentasvir, and ribavarin.

“If the results are confirmed […] molnupiravir would be the first antiviral pill against SARS-CoV-2 “

Oral antivirals against COVID-19

On October 1, the US laboratory Merck (MSD), together with Ridgeback Biotherapeutics, announced in a release, which, therefore, would soon request the officials of the United States Food and Drug Administration (FDA) to authorize its emergency use.

If the results of the press release are confirmed in peer-reviewed scientific publications, molnupiravir would be the first antiviral pill against it. SARS-CoV-2, although there are two more in development by the laboratories Pfizer and Roche.

The medicine works by causing a biological situation called bug catastrophe in the genome of SARS-CoV-2, which consists of, with which the infection does not occur.

According to the statement, a phase 3, double-blind, randomized study in 1,550 volunteers from Latin America, Europe, Africa and the United States, in which molnupiravir was being pitted against a placebo, had to be stopped early due to the benefit it demonstrated. molnupiravir.

The volunteers were patients with COVID-19 mild to moderate confirmed by laboratory test, with onset of symptoms within 5 days after the draw, and with at least one of the following conditions, obesity, age over 60 years, diabetes mellitus and heart disease, characteristics considered as risk factor for complications from this disease.

Analysis of data from the first 775 volunteers revealed that, having found that as of day 29, no deaths were reported in patients receiving molnupiravir, compared with 8 deaths in patients receiving placebo. Molnupiravir demonstrated consistent efficacy against gamma, delta, and mu variants.

The incidence of side effects was comparable in the molnupiravir and placebo groups, and interestingly, 1.3% of the volunteers had to discontinue the study due to an adverse effect, compared with 3.4% of those using the placebo.

Although the company has not announced prices, the newspaper “The New York Times” published that. The communiqué of the pharmaceutical companies clarifies that for other countries, it is planned to implement a system of tiered prices based on the World Bank criteria to measure the income of the countries according to their purchasing power.

In short, in order to have a new weapon in the fight against pandemic, which is postulated, could eventually be used at the first suspicion of contagion, thus changing the paradigm of disease treatment.

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