COVID-19 Therapeutics Updates


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Ian L. -

What about 10 days treatment - less long Covid possibly Primary HSimplex requires 10 days if given 5 days rebounds.

Ian L. -

Remdesivir 3 days Iv 200mg day 1 100mg day 2 and 3 given early has clearer proof but real world studies not revealed .In Australia being used in pregnant patients .

Sean N. -

Thanks for the comments Ian!

No data at this time to support giving longer course than 5 days of Paxlovid, this may change over time with additional studies.

James H. -

Noticed you didn’t discuss Molnupiravur. Would you still consider this a second option for patient with drug-drug interactions to Paxlovid?


Sean N. -

Hi James,

Thanks for the comments!

Yes, we did not include molnupiravir in our update.

We consider molnupiravir a third-line agent.

This is based on a few reasons including the data does not support molnupiravir is as efficacious but for a few other reasons.

Molnupiravir has an EUA for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults with positive results of direct SARS-CoV-2 viral testing who are at high risk for progression to severe COVID-19, including hospitalization or death, and for whom alternative COVID-19 treatment options approved or authorized by FDA are not accessible or clinically appropriate. Molnupiravir is a nucleoside analogue that inhibits SARS-CoV-2 replication by viral mutagenesis. There is a theoretical concern of the potential that molnupiravir may induce resistance in the virus and possibly to other antivirals.

The other concern is the concern for mutagenesis and embryo-fetal toxicity and risk to breastfeeding children.

From the EUA prescribing information.
Individuals of childbearing potential of the potential risk to a fetus and to use an effective method of contraception correctly and consistently, as applicable, during treatment with Molnupiravir and for 4 days after the final dose.

Breastfeeding: Breastfeeding is not recommended during treatment and for 4 days after the last dose of Molnupiravir. A lactating individual may consider interrupting breastfeeding and may consider pumping and discarding breast milk during treatment and for 4 days after the last dose of Molnupiravir.

Males: Advise sexually active individuals with partners of childbearing potential to use a reliable method of contraception correctly and consistently during treatment and for at least 3 months after the last dose of Molnupiravir.

Update of Paxlovid
Since our piece was published there is additional data on Paxlovid from the FDA based on Pfizer phase 2/3 study in standard risk patients.
“Pfizer’s COVID-19 drug Paxlovid (nirmatrelvir, ritonavir) has shown limited efficacy in reducing the risks of symptoms for standard-risk patients in a phase 2/3 study.
The FDA authorized the drug for emergency use for high-risk groups based on its efficacy in reducing hospitalizations and deaths in that group.
Due to a very low rate of hospitalization or death observed in the standard-risk patient population, Pfizer has decided to end enrollment in the study.”

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EM:RAP 2022 Breaking News June 14th: COVID-19 Therapeutics Updates Full episode audio for MD edition 13:05 min - 15 MB - M4A