Yesterday, the UK’s Medicine and Health products Regulation Agency (MHRA) approved the world’s first ‘take at home’ COVID-19 treatment, Lagevrio (Molnupiravir) – one of two antiviral treatments secured by the UK Government in October 2021.

People with scleroderma are often immunocompromised through the medications taken to manage their condition. Some of these medications may prevent a proper immune response to their two initial COVID-19 vaccines. Certain treatments or conditions can result in no immune response being generated.  Positively, there is emerging evidence that in some cases a third vaccine dose will offer stronger protection even if the initial two vaccines did not result in an immune response. However, there is still an urgent need to make COVID-19 treatments available for those who are less protected, ensuring that if someone catches or is exposed to COVID, their risk of hospitalisation will be significantly decreased.

Two new COVID-19 antiviral treatments, Lagevrio and PF-07321332/ritonavirare designed to treat those most at risk from COVID-19 this winter. Lagevriohas now been approved by the MHRA for treatment of those with COVID-19, who have at least one risk factor for developing a more severe illness. Most importantly, the treatment is in tablet form meaning the infected person does not need to travel – reducing the spread of COVID-19

The second antiviral, PF-07321332/ritonavir, is being assessed in stage three clinical trials, with more data needed before it can be approved by the MHRA for use in the NHS. Both antivirals will be prioritized for the treatment of vulnerable patients, including those who are immunocompromised who test positive for COVID-19 or who have been exposed to the virus.

The importance of these treatments to the immunocompromised community was focused on by Professor Jonathon Van-Tam, Deputy Chief Medical Officer, who said: “They will be particularly vital in protecting those who may not get the same antibody response to the vaccines as the majority of the population. We will now work quickly to ensure the right cohorts of people receive these treatments as soon as possible, should they be approved by the MHRA.”

So what are antivirals?

Antivirals are used to protect individuals who have been exposed to coronavirus, or to treat those who have tested positive for COVID-19. They work by targeting the virus early, preventing an individual’s progression from their initial infection to developing critical symptoms. This is achieved by halting or reducing viral replication, meaning that infection cannot take hold at the same rate or intensity as a non-treated individual would experience.

Oral antivirals compliment vaccines, and do not act as a replacement. Vaccines train your immune system to effectively fight the virus whilst antivirals directly target the virus without involving the immune system. Even, with new weapons such as Lagevrio in the armoury it is still important to access all the COVID-19 vaccinations you are eligible for.

Antiviral Fact File: Lagevrio (Molnupiravir)

• Manufacturer: Merk Sharp and Dohme
• Number secured: 480,000
• How it works: This antiviral is a nucleoside analogue, which disrupts the genetic code of the COVID-19 virus, introducing mistakes which ultimately kill off the virus.
• Stats: Reduces the risk of hospitalization or death in people with at least one risk factor for severe COVID-19 by 50%.
• How it is administered: A tablet taken twice a day, to be taken at home

Antiviral Fact File: PF-07321332/ritonavir

• Manufacturer: Pfizer
• Number secured: 250,000
• How it works: PF-07321332 is a protease inhibitor which inhibits the main protease enzyme which coronavirus needs for replication in the body. This is given in tandem with ritonavir, an antiretroviral which is frequently used in combination with protease inhibitors.
• Stats: Phase 2 and 3 trials are currently underway
• How it is administered: A tablet, to be taken at home

Once in regular use, both treatments will be included in national real world studies which will allow medical professionals to gather more data on the benefits of these drugs.

Other antiviral treatments already available include Ronapreve which SRUK have written about previously, and there are more are in development. Roche and Atea’s oral antiviral AT-527 is being assessed within the MORNINGSKY trial (phase 3). Set to conclude late in 2021, this will hopefully add another treatment to the UK’s arsenal by 2022. Antiviral drugs are of particular importance to our immunocompromised community, so SRUK will keep you up to date as future treatments become available.