Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India.
Curr Drug Res Rev. 2022;14(3):203-214. doi: 10.2174/2589977514666220527105158.
COVID-19, first detected in Wuhan, China, has evolved into a lifethreatening pandemic spread across six continents, with the global case count being more than 243 million, and mortality over 4.95 million, along with causing significant morbidity. It has initiated an era of research on repurposed drugs such as hydroxychloroquine, lopinavir/ritonavir, corticosteroids, remedesivir, ivermectin, alongside selective antivirals to treat or prevent COVID- 19. Molnupiravir is an orally available emerging antiviral drug considered highly promising for COVID-19.
We have performed a scoping review for the use of molnupiravir against SARS-CoV-2 and COVID-19. It acts by inhibiting RNA-dependent RNA polymerase (RdRp), and exhibits broad-spectrum antiviral activity. Preclinical studies have evaluated the therapeutic efficacy as well as prophylactic activity of molnupiravir against SARS CoV-2 in various animal models that include ferrets, hamsters, mice, immunodeficient mice implanted with human lung tissue and cell cultures, in various doses ranging from 5-300 mg/kg, and results have been encouraging. Initial evidence of safety and efficacy from early phase clinical studies has been encouraging too, and recent results from a large phase 3 global trial have shown significant benefits among symptomatic outpatients. Other late-phase clinical trials are still underway with the aim of establishing molnulpiravir as a therapeutic option for COVID-19, particularly for non-hospitalized patients.
On the basis of the limited evidence available as of now, molnupiravir could prove to be a promising oral therapy, worthy of further exploration of its utility for both treatment and prevention of COVID-19 in humans. Elaborate clinical evaluation is further warranted to confirm whether the results are replicable to the clinical scenario among outpatients to reduce the chance of progression to more severe disease.
COVID-19 最初在中国武汉被发现，现已演变成一种危及生命的大流行病，在六大洲传播，全球病例数超过 2.43 亿，死亡人数超过 495 万，同时导致大量发病。它开创了研究再利用药物的时代，如羟氯喹、洛匹那韦/利托那韦、皮质类固醇、瑞德西韦、伊维菌素以及选择性抗病毒药物来治疗或预防 COVID-19。Molnupiravir 是一种口服可用的新兴抗病毒药物，被认为对 COVID-19 有很高的治疗潜力。
我们对 Molnupiravir 治疗 SARS-CoV-2 和 COVID-19 的应用进行了范围界定审查。它通过抑制 RNA 依赖性 RNA 聚合酶（RdRp）起作用，并表现出广谱抗病毒活性。临床前研究评估了 Molnupiravir 在各种动物模型（包括雪貂、仓鼠、小鼠、植入人肺组织的免疫缺陷小鼠和细胞培养物）中对 SARS CoV-2 的治疗效果和预防活性，剂量范围为 5-300mg/kg，结果令人鼓舞。早期临床试验的初步安全性和疗效证据也令人鼓舞，最近一项大型 3 期全球试验的结果表明，在有症状的门诊患者中，Molnupiravir 具有显著益处。其他后期临床试验仍在进行中，目的是确立 Molnulpiravir 作为 COVID-19 的治疗选择，特别是对非住院患者。
根据目前有限的证据，Molnupiravir 可能被证明是一种很有前途的口服治疗药物，值得进一步探索其在人类 COVID-19 的治疗和预防中的应用。需要进一步进行详细的临床评估，以确认结果是否可以复制到门诊患者的临床情况中，从而降低疾病进展为更严重疾病的机会。
