Dear all, I wish to talk about the two new oral molecules launched in covid care. 1) Molnupiravir (Merck) 2) Nirmatrelvir+ ritonavir (Pfizer). First one is molnupiravir. This is developed by Merck and ridge back biotherapeutics in conjunction with the Emory university. It is a small molecule ribonucleotide. It is a pro drug of NHC ( N-hydroxycytidine) which gets incorporated into the viral genome and misdirects the viral polymerase. This causes harmful errors in the viral genome and kills the virus. The drug affects all variants of covid virus like delta, mu etc. This molecule was studied in the phase 3 MOVe-out trial. The study aimed to recruit 1550 patients. These were mild to moderate non hospitalised covid patients with atleast one comorbidity, unvaccinated, started on molnupiravir within 5 days of symptoms. They were given 800 mg twice a day for 5 days. After completion of 50% of enrollment which is 750 patients an interim analysis was done on day 29. It showed 50% decreased hospital admissions as compared to placebo group. Given the high success rate the trial was stopped early and emergency use authorisation was sought from the US FDA. Cost of treatment in USA is 700$ for 5 days. Indian side of the trials: Hetero pharmaceutical has completed an independent trial and data is with DGCI. Dr Reddy, Sun pharma, emcure, cipla, torrent, mylan have formed a consortium and done a join trial. Data with DGCI. Expected launch cost is 15 to 20$ for 5 days treatment in india as per sources. Emergency use authorisation is now granted to molnupiravir in India. Once it is available in the indian market it will make covid care easier. It will be available as 200 mg capsules. Second new oral molecule is from pfizer and called paxlovid ( nirmatrelvir+ ritonavir). It is a protease inhibitor. More details in a second write up tomorrow. Dr Hardik Thakker , MD MED, ECFMG (USA), COVID expert.