The emergence of Molnupiravir of MSD, known as the first oral treatment for COVID-19, is drawing attention to how it will affect the war against COVID-19. While it is compared to Tamiflu and is evaluated as a game changer, there are mixed views on the other side that its role may be limited due to price limitations.
According to the interim results of phase 3 clinical trials of MOVe-OUT, which evaluated the efficacy of the oral corona treatment Molnupiravir by MSD on the 1st, 775 patients with mild and moderate symptoms had reduced hospitalization and mortality by about 50%, satisfying the primary evaluation index.

At this time, the dose of Molnupiravir was taken twice a day, 10 times for 5 days, and as a result, 7.3% of patients worsened to severe and there were no deaths. 14.1% of patients taking placebo worsened to severe and 8 died.

Based on these clinical results, MSD terminated the clinical trial early without the registration of additional clinical patients originally planned and submitted an application for emergency use approval to the FDA.

Considering the trend so far, Molnupiravir, which has been effective in clinical trials, is cheaper than conventional injections, so it will not be too much to win the title of the first oral treatment for COVID-19. The FDA will closely review safety and effectiveness data to determine whether to approve or not, and a final conclusion is expected within a few weeks.

"The reason for getting a vaccine is to prevent it from going from mild to severe, that is, how severe it is even if it is a breakthrough infection," said Kang Jinhan, head of the Vaccine Bio Research Institute at Catholic University. "In the case of flu, the prevention rate is only about 50%, but the oral treatment of COVID-19 will be meaningful in that way."

Director Kang said, "There is a need for oral treatments as a strategy to go to the so-called With Corona like the flu," adding, "I think it will be a concept that prevents medical confusion by administering it early so that mild patients do not get serious."

Can Molnupiravir, which has been proven effective, be like Tamiflu?

One question here is whether Molnupiravir can play the same role as Tamiflu or Xofluza, a flu treatment, at a time when many experts predict that COVID-19 will become endemic like the flu in the future.

According to the most recently developed CAPSTONE-1 clinical study by Xofluza, the median time required for the Xofluza administration group to relieve symptoms after administration was about 2.3 days (Tamiflu 3.3 days). In addition, the median time it took to fever was about 1 day (Tamiflu 1.8), and the effect of reducing virus levels was reduced by half in about 1 day (Xofluza about 4 days).

Choi Young-joon (pediatric infection), a professor at Korea University Anam Hospital, said, "I remember that Tamiflu was first introduced as an endpoint and gradually expanded to shorten the duration of symptoms," adding, "Molnupiravir aims to treat death and severe infections in public health and may expand the scope of treatment in the future."

In fact, according to the MOVe-OUT clinical evaluation index that evaluated the efficacy of Molnupiravir, the primary evaluation index is the rate of hospitalization, death, and side effects, but the second evaluation index is the decomposition or improvement time of the coronavirus, so the possibility remains. Another variable is that the expected price of Molnupiravir is set at about 830,000 won ($700). As a result, the current market for oral treatments for COVID-19 is expected to form from about 7 trillion won (6 billion dollars) to about 8 trillion won (7 billion won).