INTRODUCTION
Coronavirus disease (COVID-19) which is defined as a severe acute
respiratory syndrome caused by a coronavirus, and hence also known as
SARS-CoV-2 has created a devastating situation, infecting 610 million
people along with 6.5 million deaths worldwide. [1]
Since the virus has a rapidly mutating property, many new variants have
emerged increasing infectivity and transmission. The Omicron variant
that is currently dominating has a higher infectivity and strong vaccine
breakthrough ability and among the three lineages (BA.1, BA.2, BA.3) of
this variant, BA.2 has become a “variant of concern” increasing
hospitalization. [2,3]
Although many patients recover without treatment, a significant number
of patients infected with COVID-19 need hospitalization, especially the
ones with pre-existing conditions such as diabetes mellitus, obesity,
and cardiac conditions. Although the administration of vaccines and
various techniques are effective in reducing the incidence of
hospitalization and death, its coverage remains insufficient.
[4,5,6]
The need for initiation of treatment is required at the earliest after
the onset of symptoms, and therapies that can be easily administered by
patients are needed since no therapies have been shown to eliminate the
infectious virus and prevent transmission, oral antivirals are needed.
There are two classes of antiviral drugs authorized for COVID-19
treatment; remdesivir and monoclonal antibodies. Remedesivir is approved
by the FDA for the treatment of severe COVID-19 patients hospitalized.
[7] Molnupiravir (also known as EIDD-2801/MK-4482), which is used as
an antiviral drug is an orally administered, small molecule
ribonucleoside prodrug of N-hydroxycytidine that is rapidly metabolized
by esterases and absorbed into the system and acts by phosphorylating
into NHC-triphosphate intracellularly, incorporating into the viral
genome increasing errors, mismatch and misdirects the viral polymerase,
leading to accumulation of deleterious errors and halting viral RNA
replication of SARS-CoV-2 and other RNA viruses. [4,6,8]
In the first 5 days of infections, when the patient is characterized by
an early peak viral load, any antiviral administered early can have the
most effect on the infection. Molnupiravir has three doses for
administration (200mg, 400mg, and 800mg) that significantly reduce viral
titers and block transmission to uninfected people. Studies have shown
that molnupiravir administered in PCR-positive patients in
aforementioned doses twice daily for 5 days, was found negatively
cultured in all the patients after administration of the drug compared
to placebo. [8] Molnupiravir was found well tolerated and has a
shred of strong evidence that it is not mutagenic or genotoxic in
mammals even at exposure above therapeutic targets, however, it has
several adverse effects which can be mild-severe. [6,9] Our
meta-analysis aims to evaluate virology profile, and adverse effects
associated with the use of molnupiravir on a large patient population.