Oral antivirals for the prevention and treatment of SARS-CoV-2 infection

Vaccines and antivirals are the classical weapons deployed to contain, prevent, and treat life-threatening viral illnesses. Specifically, for SARS-CoV-2 infection, vaccines protect against severe COVID-19 disease manifestations and complications. However, waning immunity and emergence of vaccine escape mutants remains a growing threat. This is highlighted by the current surge of the omicron COVID-19 variant. Thus, there is a race to find treatment alternatives. We contend that oral small molecule antivirals that halt SARS-CoV-2 infection are essential. Compared to currently available monoclonal antibodies and remdesivir, where parenteral administration is required, oral antivirals offer treatments in an outpatient setting with dissemination available on a larger scale. In response to this need at 2021's end, regulatory agencies provided emergency use authorization for both molnupiravir and nirmatrelvir. These medicines act on the viral polymerase and protease, respectively. Each is given for 5 days and can reduce disease progression by 30% and 89%, respectively. The advent of additional oral antivirals, the assessment of combination therapies, the formulation of extended-release medications, and their benefit for both early treatment and prophylaxis will likely transform the landscape of the COVID-19 pandemic.

Automated summary

Vaccines and antivirals are critical in preventing, controlling, and treating viral diseases. For SARS-CoV-2 infection, vaccines offer protection against severe COVID-19 symptoms and complications, but waning immunity and emergence of escape mutants pose ongoing threats. Oral antivirals that can be administered in outpatient settings and on a larger scale are essential. Emergency use authorizations have recently been granted for two oral antivirals, molnupiravir and nirmatrelvir, which have shown significant reductions in disease progression.