WHO Backs Merck’s Antiviral Pill For High-Risk Covid Patients But Finds Regeneron’s Antibody Cocktail ‘Ineffective’ Against Omicron

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The World Health Organization has recommended Merck’s molnupiravir to treat high-risk Covid patients, the agency announced Thursday, the first oral antiviral it has endorsed though availability is still limited globally despite efforts to ramp up production.

Molnupiraviris given to high-risk Covid patients early on in the disease.

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Key Facts

The WHO expert panel endorsed molnupiravir for Covid patients at high risk of hospitalization but who do not yet have severe illness, developed by Merck and Ridgeback Biotherapeutics, following new data from six clinical trials involving nearly 4,800 patients, the agency said.

High risk groups typically include older people, the unvaccinated, the immunocompromised and people with chronic diseases, the WHO said.

The panel suggested children and people who are pregnant or breastfeeding should not be given the drug due to potential risks to the developing fetus flagged in animal studies, adding that contraceptives and pregnancy tests should be available at the point of care for health systems offering the drug.

As the drug is a new medicine, the panel said there is “little safety data” and the WHO recommends monitoring for drug safety.

Despite efforts to boost supplies, including a licensing agreement to share the pill with poorer countries, molnupiravir is still “not widely available,” the WHO said, clustered in typically wealthy countries that rushed to secure early supplies.

The updated recommendations, which are continually refreshed to provide doctors with up-to-date advice during the pandemic, also backed the restriction of Regeneron’s antibody cocktail in patients infected with omicron, citing evidence the treatment “is ineffective against” the widespread variant.

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Changing guidance. The WHO panel said it is evaluating several other medicines for recommendation. One medication under consideration is Pfizer’s paxlovid, another antiviral pill typically recommended for patients without severe illness to prevent progression towards severe illness and hospitalization. The panel is also considering fluvoxamine, a cheap and widely available antidepressant drug that has shown promise at treating Covid in some early clinical trials. Guidance for remdesivir is also being reviewed, based on data from new trials.

Key Background

Molnupiravir was the first oral antiviral approved for Covid-19 and widely hailed as a gamechanger for efforts to control the virus. To be taken at home before symptoms developed, the pill plugged a crucial gap in the treatment of Covid-19, which previously relied on prevention (such as vaccination), treating the most severe cases in hospital or tricky-to-administer on-site treatments for those not in hospital. Enthusiasm for the drug has since been eclipsed by Pfizer’s paxlovid, which studies show is nearly 90% effective at preventing hospitalization and death in high risk groups. By contrast, initial data suggested molnupiravir halved the risk of hospitalization in high risk groups, though later studies found this to be much lower, around 30%.

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