DH Deciphers | Covid pills: Do they work? When will India get them?

Two new antiviral drugs manufactured with the express purpose of combating the novel coronavirus are on the verge of entering the worldwide market. Although at least one drug could potentially become available in India in the next few weeks, this does not mean that Indians should avoid getting vaccinated. Here's what you need to know about these drugs:

What are these drugs?

The first is the drug Molnupiravir, developed by Merck & Co, Inc which was announced in October and the second is Paxlovid, developed by Pfizer. Both drugs are in the process of getting emergency use authorisation in the US and in other countries. In India, Dr Ram Vishwakarma, Chairman of the Covid Strategy Group, told DH that the EUA for Molnupiravir could happen soon because a precedent has already been set by the UK’s approval of the drug on November 4.

How effective are they?

Both the pills have been found to be effective at preventing severe illness among at-risk people who received the drug soon after they exhibited symptoms. Studies show that Paxlovid cuts the risk of hospitalisation or death by 89 per cent when given within three days of the start of symptoms. In the overall study population, no deaths were reported in patients who received the drug as of Day 28 of the study. However, 10 patients who received a placebo succumbed to Covid-19. In the case of Molnupiravir, while 14.1 per cent of a sample group of 775 Covid-19 patients who received it either required hospitalisation or died, only 7.3 per cent of patients who received the drug required hospitalisation through day 29 of Phase 3 human trials.

Will India get these drugs soon?

Yes and Molnupiravir could be the first. “Data for Molnupiravir is with the regulator in India. It is being looked at by the Subject Expert Committee. Within the next month, there would be a decision on approval,” Dr Vishwakarma said. He added that five companies in the country have already started manufacturing the drug.

What about the Pfizer drug?

Experts say it could be inevitable that Paxlovid will follow the Merck drug into India, notably because Pfizer would have to use India’s sprawling drug manufacturing sector to scale up production of the medicine for the worldwide market.

How much would it cost?

While the Merck drug is expected to cost up to $700 in the US, it may be cheaper in India. Dr Vishwakarma said bulk buying by the Centre would reduce the cost to between Rs 2,000 and Rs 4,000 but the price would eventually drop down to between Rs 500 and 1,000. The Pfizer drug, which is described as being more effective in terms of hitting the mark, could cost slightly more.

Can these drugs be used to replace vaccination?

No, experts say, adding that vaccines have been vitally important in slowing the pandemic but that people whose doses are pending must finish their course. The drugs will be critical in addressing breakthrough infections. They are also not expected to render booster shots obsolete. Doctors advise that people should have access to boosters to improve their immunity if needed.

What is the duration of treatment and are there any side-effects?

A full course of Molnupiravir treatment runs for five days. Some experts say there should be caution in prescribing it to pregnant women. Paxlovid is actually a combination of an antiviral and another drug called Ritonavir, which is often used in HIV treatment cocktails and can affect the metabolisation of other medications. This means it possibly should not be given in conjunction with other drugs such as painkillers, heart drugs and medicines that suppress the immune system.

Is this the death knell for Covid-19?

This is the beginning of the death knell, Dr Vishwakarma said. “In six months, I am confident that we will see a drug cocktail that will be highly effective in treating Covid-19 which has already become endemic in India. The emergence of these drugs is a significant milestone, on a par with the approval of AZT to treat HIV in March 1987.”

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