A study published on Tuesday in the esteemed peer-reviewed journal Nature, has raised concerns that the anti-COVID drug molnupiravir, marketed under the name Lagevrio and developed by Merck, may be contributing to mutations in the SARS-CoV-2 virus.
Originally designed to combat influenza, molnupiravir gained approval from the US Food and Drug Administration in late 2021 and has been widely administered to COVID patients at risk of developing severe complications.
The drug’s mechanism of action involves inducing errors in the genetic code of the SARS-CoV-2 virus, effectively hindering its replication process.
Conducted by scientists at the Francis Crick Institute in London, the study suggests that if molnupiravir treatment does not completely clear the SARS-CoV-2 infection from the body, it could potentially lead to the transmission of mutations associated with the drug.
Researchers examined global sequencing databases housing more than 15 million SARS-CoV-2 genomes, focusing on mutations in sequences from the year 2022, following the introduction of molnupiravir treatment. These mutations were notably identified in countries where the drug was widely used, including the United Kingdom, Australia, the United States, and Japan. Conversely, countries that did not authorize molnupiravir usage, such as Canada, exhibited fewer of these mutations in their screened sequences.
In January 2022, Israel’s Ministry of Health approved the use of molnupiravir and secured a purchase agreement for the drug, priced at $700 per treatment course for one individual. The ministry specified that molnupiravir was intended for individuals aged 18 and above with mild to moderate COVID symptoms who possessed at least one risk factor for deterioration leading to hospitalization or death, and for whom alternative drugs, such as Pfizer’s Paxlovid, were not suitable or accessible. Administered in tablet form, molnupiravir is intended for home use within three to five days of symptom onset and is taken over a five-day period. It is not recommended for use as a prophylactic measure against COVID or for pregnant or breastfeeding women.
Sheba Medical Center in Ramat Gan, Israel, collaborated with Merck in early trials of molnupiravir for COVID-19. These trials indicated that the drug was effective in preventing hospitalization and death in approximately 30% of test subjects. However, the full implications and consequences of the molnupiravir-associated mutations highlighted in the Nature study remain uncertain.
The study’s authors cautioned, “These results indicate that molnupiravir treatment has produced a signature mutation profile that is identifiable in sequence databases, a finding that should be considered when assessing the effects and safety of this drug.” They further noted, “However, whether molnupiravir might alter the trajectory of variant generation or transmission is difficult to predict.”
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