Five-Day Course Of Oral Antiviral Appears To Stop SARS-CoV-2
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A single pill of the investigational drug molnupiravir taken twice a day for 5 days eliminated SARS-CoV-2 from the nasopharynx of 49 participants. In this phase 2a, randomized, double-blind control trial, researchers recruited 202 adults who were treated at an outpatient clinic with fever or other symptoms of a respiratory virus and confirmed SARS-CoV-2 infection by day 4.

Participants were randomly assigned to three different groups: 200 mg of molnupiravir, 400 mg; or 800 mg. The 200 mg arm was matched one-to-one with a placebo-controlled group, and the other two groups had three participants in the active group for every one control. Participants took the pills twice daily for 5 days, and then were followed for a total of 28 days to monitor for complications or adverse events.

At days 3, 5, 7, 14, and 28, researchers also took nasopharyngeal swabs for PCR tests, to sequence the virus, and to grow cultures of SARS-CoV-2 to see if the virus that's present is actually capable of infecting others. Notably, the pills do not have to be refrigerated at any point in the process, alleviating the cold-chain challenges that have plagued vaccines.

Of the 202 people recruited, 182 had swabs that could be evaluated, of which 78 showed infection at baseline. By day 3, 28% of patients in the placebo arm had SARS-CoV-2 in their nasopharynx, compared to 20.4% of patients receiving any dose of molnupiravir. But by day 5, none of the participants receiving the active drug had evidence of SARS-CoV-2 in their nasopharynx. In comparison, 24% of people in the placebo arm still had detectable virus.

By day 3 of the 5-day course, 36.4% of participants in the 200 mg group had detectable virus in the nasopharynx. The reduction in SARS-CoV-2 was noticeable in both the 200mg and 400mg arms. But it was only statistically significant in the 800 mg arm.

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