This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.
What you need to know
-
Molnupiravir and nirmatrelvir plus ritonavir have been licensed by the Medicines and Healthcare products Regulatory Agency for the treatment of covid-19 in adults.
-
Evidence of clinical efficacy for each drug is based on interim analysis of data from a single placebo-controlled trial in unvaccinated adults.
-
Both trials recruited non-hospitalised adults with mild-to-moderate covid-19 who had at least one risk factor for severe covid-19 illness.
-
The risk of hospitalisation or death was reduced when molnupiravir (NNT 33) or nirmatrelvir plus ritonavir (NNT 18) was started within 5 days of onset of covid-19 symptoms.
-
Common adverse effects with molnupiravir include diarrhoea, nausea and dizziness.
-
Common adverse effects with nirmatrelvir plus ritonavir include dysgeusia, diarrhoea and vomiting.
-
Nirmatrelvir plus ritonavir has an extensive list of possible serious and life-threatening drug interactions.
Introduction
In the UK, since the start of the covid-19 pandemic in 2019, there have been over 165 000 deaths within 28 days of a positive test and over 185 000 deaths in which covid-19 was listed on the death certificate.1 A successful programme of vaccination against SARS-CoV-2 has delivered over 140 million doses since being introduced in December 2020.2 Nevertheless, covid-19 continues to cause serious illness, hospitalisation and death. A parallel strategy to the introduction of vaccines against covid-19 has been the development of antiviral drugs to treat people who have been infected with SARS-CoV-2. Two oral antiviral products have been authorised by the Medicines and Healthcare products Regulatory Agency (MHRA) for the treatment of covid-19 in adults.3 4 Here, we provide an overview of both drugs.
