Comprehensive review on molnupiravir in COVID-19: a novel promising antiviral to combat the pandemic

Abstract

Despite the progress in the management of COVID-19, effective oral antiviral agents are still lacking. In the present review, the potential beneficial effects of molnupiravir in the management of COVID-19 are discussed. A literature search in Google Scholar, Scopus, PubMed and clinicaltrials.gov for the relevant articles regarding the pharmacokinetics, pharmacodynamics and clinical trials of molnupiravir in the management of COVID-19 is conducted. Most of the preclinical studies and available clinical trials showed a favorable short-term safety profile of molnupiravir; however, given its possible genotoxic effects, further trials are required to confirm the long-term efficacy and safety of molnupiravir in patients with COVID-19.

Keywords: COVID-19; MK-4482; SARS-CoV-2; direct-acting antivirals; molnupiravir.

Figure 1.. The mechanisms of action of molnupiravir against SARS-CoV-2.

Molnupiravir (EIDD-2801) is converted to its active form NHC (EIDD-1931) via plasma esterase. NHC is distributed throughout the fluid and tissues in the body. In the host cells, NHC is phosphorylated to form NHC 5′-triphosphate. The RdRp wrongly uses NHC 5′-triphosphate instead of uridine triphosphate and cytidine triphosphate, which resulted in RdRp inhibition, RNA chain termination and mutagenesis. ACE-2: Angiotensin convertin enzyme 2.