SWITZERLAND –The World Health Organization has conditionally recommended the antiviral drug molnupiravir for patients with non-severe COVID-19 infection who are at high risk of hospitalization.

The WHO Guideline Development Group of international experts’ panel stated that the recommendation was for patients who are at the highest risk of hospitalization, such as those who are unvaccinated, the elderly, and those with weakened immune systems or chronic diseases.

However, the panel has warned against using the drug on young and healthy patients, including children, pregnant and breastfeeding women.

The WHO’s recommendation is based on the results of six randomized controlled trials involving 4,796 patients, “the largest dataset on this drug so far.”

According to the report, the moderate certainty evidence from these trials suggests that molnupiravir reduces the risk of hospitalization with 43 fewer admissions per 1,000 patients at highest risk.

Molnupiravir also helped in increasing the time of symptom resolution by average 3.4 days.

Mitigation strategies

According to the statement, the panel describes population-level mitigation strategies, such as pharmacovigilance and antiviral resistance monitoring, in light of concerns about genotoxicity (damage to a cell’s genetic information resulting in mutations), the emergence of resistance, and the emergence of new variants.

The panel made no recommendations for patients with severe or critical illnesses because there are no trial data on molnupiravir for this population, according to the statement.

The panel acknowledged that molnupiravir’s cost and availability issues may make access difficult in low and middle-income countries, exacerbating health inequity.

Molnupiravir is the world’s first pill to treat symptomatic Covid. The antiviral drug developed by Merck is being hailed as the gamechanger for high-risk individuals and people with weakened immunity and reportedly cuts the risk by half.

Twenty-seven pharmaceutical companies in low- and middle-income countries have been licensed to manufacture generic versions of molnupiravir.

They make no recommendation for patients with severe or critical illness as there are no trial data on molnupiravir for this population.

And they acknowledge that cost and availability issues associated with molnupiravir may make access to low- and middle-income countries challenging and exacerbate health inequity.

In the same guideline update, the panel recommends a treatment combining two antibodies (casirivimab and imdevimab) to be used in people who are confirmed not to have the omicron variant, as new evidence demonstrates a lack of effectiveness against the omicron variant.

Covid treatment arsenal

The panel’s recommendations are part of a living guideline, developed by the World Health Organization with the methodological support of MAGIC Evidence Ecosystem Foundation, to provide trustworthy guidance on the management of covid-19 and help doctors make better decisions with their patients.

The guidance adds to previous recommendations for the use of Eli Lilly’s Baricitinib, interleukin-6 receptor blockers and systemic corticosteroids for patients with severe or critical covid-19.

In addition, for the use of sotrovimab for patients with non-severe covid-19 and against the use of convalescent plasma, ivermectin and hydroxychloroquine in patients with covid-19 regardless of disease severity.

The recommendation for remdesivir is undergoing review due to new trial data. Recommendations for fluvoxamine and nirmatrelvir/ritonavir are currently in preparation.

In recent weeks, government regulators have also approved new oral treatments for the disease, including Paxlovid, a Pfizer antiviral pill that demonstrated nearly 90% efficacy in preventing hospitalization and death in high-risk patients.

According to Pfizer, paxlovid also retained its effectiveness with Omicron.

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