Lagevrio (molnupiravir) / Emory University, Ridgeback Biotherap, Merck (MSD), Cipla - LARVOL DELTA

Prognostic factors in the selection of antivirals for COVID-19 in high-risk outpatients: A retrospective cohort study. (PubMed, Ther Adv Infect Dis) - "Drug-drug interaction concerns, particularly between ritonavir and statins, drove physicians toward molnupiravir even when nirmatrelvir/ritonavir would otherwise have been the preferred agent. Systematic incorporation of pharmacist-conducted medication assessment before antiviral prescribing represents a practicable strategy for reducing avoidable drug substitution in high-risk patients."

Biomarker • Journal • Retrospective data • Infectious Disease • Novel Coronavirus Disease

Deep learning survival analysis with time-varying covariates: extending PyCox to assess COVID-19 antiviral treatments and long-COVID associations. (PubMed, JAMIA Open) - "We compared traditional Cox regression, original PyCox, and modified PyCox in estimating associations between early antiviral treatment (nirmatrelvir or molnupiravir) and long-COVID. Treatment-contrast magnitude and covariate importance varied by models, suggesting temporal covariate structure and modeling approach jointly influence treatment-effect estimates. Extending PyCox to accommodate time-varying covariates improves computational efficiency while maintaining estimation accuracy comparable to standard time-varying methods."

Journal • Infectious Disease • Novel Coronavirus Disease

Potent halt of SARS-CoV-2 replication using clitocine-induced emergent-viral-RNA editing and disruption. (PubMed, RSC Adv) - "The in vitro anti-RdRp, anti-ExoN, and anti-SARS-CoV-2 assays demonstrated the potent inhibitory activities of the CLT molecule and its expected major active metabolite, CLT triphosphate (CLT-TP), on coronaviral replication, with very interesting 50% inhibitory concentration (IC50) values against the nirmatrelvir-resistant SARS-CoV-2 variant "NRSV" (0.19, 0.20, and 0.38 µM for CLT and 0.15, 0.18, and 0.34 µM for CLT-TP, respectively), using the structurally similar and approved anti-SARS-CoV-2 medication molnupiravir (MNP) and its known active triphosphate metabolite, β-D-N 4-hydroxycytidine 5'-triphosphate (NHC-TP), respectively, as reference drugs. Through this new study, we also succeeded in uncovering and explaining the molecular-level mechanistic hallmarks of CLT/CLT-TP with respect to disrupting and impairing the coronaviral replication, as well as militating COVID-19 in a comprehensive way. In conclusion, the presented results need to be..."

Journal • Infectious Disease • Novel Coronavirus Disease • Oncology • Respiratory Diseases

Fatal Pharyngeal Cellulitis Caused by Rhizopus microsporus in a Patient with Acute Myeloid Leukemia. (PubMed, Infect Drug Resist) - "Despite surgical intervention and combination antimicrobial therapy (amphotericin B, posaconazole, daptomycin, ceftriaxone, and molnupiravir), the patient stabilized for 2 months before culminating in fatal carotid artery rupture. Rhizopus microsporus-related pharyngeal cellulitis is rare yet highly aggressive, demanding timely diagnosis and close monitoring. This case highlights the critical role of rapid mNGS in diagnosing polymicrobial infections, underscores the necessity of combining aggressive surgical debridement with antifungal/antimicrobial regimens, and stresses rigorous surveillance to prevent life-threatening vascular complications."

Journal • Acute Myelogenous Leukemia • Acute Respiratory Distress Syndrome • Dermatology • Hematological Malignancies • Infectious Disease • Leukemia • Novel Coronavirus Disease • Oncology • Otorhinolaryngology • Pneumonia • Respiratory Diseases

Ursodeoxycholic Acid Reduces Angiotensin-Converting Enzyme 2 Activity and Suppresses Cytokine Storm Syndrome in Patients With Coronavirus Disease 2019. (PubMed, MedComm (2020)) - "To investigate the role of UDCA in decreasing SARS-CoV-2 infection and affecting COVID-19 cytokine levels, COVID-19 patients (n = 142, male = 72, female = 70) were divided into UDCA-free (n = 53) and UDCA (n = 89) groups and treated with nirmatasvir/ritonavir or molnupiravir for 5 days. Among the 46 cytokines analyzed, luminex profiling revealed that 21 proinflammatory cytokines, including CTACK, bFGF, G-CSF, GM-CSF, GRO-α, IL-1β, IL-1Ra, IL-2, IL-2Rα, IL-6, IL-10, IL-16, IP-10, MCP-1, MCP-3, MIG, TNF-α, TRAIL, VEGF, IL-9, and IL-18, were significantly lower with UDCA treatment (p < 0.01), whereas only eotaxin levels increased (p < 0.05). Therefore, UDCA reduces ACE2 activity, improves clinical outcomes, and suppresses cytokine storm syndrome (CSS) in COVID-19 patients."

Journal • Infectious Disease • Novel Coronavirus Disease • Respiratory Diseases • ACE2 • CCL11 • CSF2 • IL10 • IL16 • IL18 • IL1B • IL1R1 • IL2 • IL6 • IL9 • TNFA

Efficacy and Safety of Nirmatrelvir/Ritonavir and Molnupiravir in Non-Hospitalized Patients with COVID-19: A Single-Center Retrospective Study. (PubMed, Medicina (Kaunas)) - "Among patient-reported symptoms effects, the incidence of dysgeusia was significantly higher in patients treated with NMV/r (p = 0.001). Both antivirals showed similarly low progression, hospitalization, and mortality rates."

Journal • Retrospective data • Infectious Disease • Novel Coronavirus Disease • Respiratory Diseases

A validated bioanalytical LC-MS/MS method for the simultaneous determination of molnupiravir, N-hydroxycytidine, and baricitinib in human plasma. (PubMed, Bioanalysis) - "Escitalopram was selected as the internal standard owing to its consistent extraction recovery, and satisfactory chromatographic performance. Normalized matrix factors for MPV, NHC, and BARI ranged from 0.948-0.984, 0.900-0.902, and 0.912-1.014, respectively, with CV values below 1%, indicating negligible matrix interference. The proposed method provides a reliable analytical tool for future pharmacokinetic and therapeutic drug monitoring studies."

Journal • Infectious Disease • Novel Coronavirus Disease

Treatment of acute COVID-19 in the community. (PubMed, Aust Prescr) - "Molnupiravir is used when nirmatrelvir with ritonavir is unsuitable. Inhaled and oral glucocorticoids and immune therapies have no role in routine community treatment of mild to moderate COVID-19. Vaccination remains the single most effective intervention for reducing the risk of severe disease and should be actively encouraged, particularly in unvaccinated or vaccine-hesitant individuals."

Journal • Review • Infectious Disease • Novel Coronavirus Disease • Respiratory Diseases

Sustained clinical remission and long-term safety of molnupiravir as first-line therapy for effusive feline infectious peritonitis: a 40-week retrospective study. (PubMed, Vet Anim Sci) - "In summary, molnupiravir is highly effective and safe as first-line treatment for effusive FIP. The transient nature of hepatic enzyme elevation and long-term hematological and renal stability provide strong clinical assurance for its long-term safety profile and the potential for a sustained clinical cure."

Journal • Retrospective data • Hematological Disorders • Infectious Disease • Novel Coronavirus Disease

Plasma concentrations of nirmatrelvir and molnupiravir required for inhibition of SARS-CoV-2 replication differ between rhesus macaques and humans. (PubMed, Antimicrob Agents Chemother) - "Our model estimates that 10-fold higher plasma nirmatelvir concentrations are needed in humans versus RMs to achieve 50% reduction in viral replication, whereas 20-fold lower plasma molnupiravir concentrations are needed. Our results suggest that dose optimization in humans based on modeling of NHP viral loads is limited by drug-specific differences in pharmacokinetic, pharmacodynamic, and virologic profiles, and that data from human phase 1 and 2 trials are better suited for this task."

Journal • Infectious Disease • Novel Coronavirus Disease • Respiratory Diseases

How Feasible is the Use of Saliva for Antiviral Therapeutic Drug Monitoring? A Systematic Review and Analysis. (PubMed, Clin Pharmacokinet) - "Studies documenting both saliva and plasma concentrations were scarce, and data was inconsistent. Findings from clinical studies sometimes contradicted predictions of penetration based on drug properties, suggesting that other factors, such as drug transporters, may significantly influence the salivary excretion of antivirals. Future robust, standardised investigations are required to confirm the clinical utility of saliva-based TDM. Feasibility is therefore currently inconclusive, but preliminary evidence is promising."

Journal • Review • Infectious Disease

On neighborhood degree sum-based indices of Nirmatrelvir and its QSPR investigation with some other COVID-19 drugs. (PubMed, In Silico Pharmacol) - "Furthermore, we present the QSPR analysis using curvilinear regression models among the obtained topological indices and physicochemical properties of the antiviral COVID-19 drugs, such as Molnupiravir, Arbidol, Chloroquine, Hydroxychloroquine, Thalidomide, Remdesivir, Ritonavir, Theaflavin and Lopinavir, including Nirmatrelvir. The results reveal that several considered indices show significant correlations with the physicochemical properties and cubic regression models consistently provide superior predictive accuracy. These findings demonstrate neighborhood degree sum-based topological indices as robust and reliable molecular descriptors in QSPR modelling, highlighting their significant potential for effective prediction of drug properties and their valuable role in facilitating rational drug design and development."

Journal • Infectious Disease • Novel Coronavirus Disease • Respiratory Diseases

Evaluating the Effectiveness of Antivirals for COVID-19 in the Post-vaccine, Omicron Era: A Systematic Review and Meta-analysis. (PubMed, Open Forum Infect Dis) - "Observational studies of nirmatrelvir-ritonavir, but not molnupiravir, consistently suggested a benefit against these outcomes. PROSPERO (CRD420251266532)."

Journal • Retrospective data • Infectious Disease • Novel Coronavirus Disease • Respiratory Diseases

The transplacental transfer of NHC, the active metabolite of molnupiravir, in the ex vivo human placental perfusion model. (PubMed, Can J Physiol Pharmacol) - "The average fetal:maternal concentration ratio was 0.48 for placentas perfused with 2.97 μg/mL, and 0.57 for those perfused with 29.7 μg/mL. These results suggest that significant concentrations of molnupiravir will reach the fetus and given the risk for teratogenicity, this therapeutic should be avoided in pregnancy unless maternal morbidity is severe and no safer alternatives exist."

Journal • Preclinical • Infectious Disease • Novel Coronavirus Disease

Computational Investigation of Molnupiravir Synthetic Intermediates: DFT and Molecular Simulation. (PubMed, Curr Med Chem) - "Integrated analysis identifies M-SI3 as the top candidate, combining balanced pharmacological properties with superior target binding and exceeding Molnupiravir's affinity."

Journal • Infectious Disease • Novel Coronavirus Disease • Respiratory Diseases

Mitigating intellectual property barriers to HIV and comorbidities treatment in Eurasian Patent Organization countries: programme results and policy implications (AIDS 2026) - "The drugs included tenofovir/emtricitabine (Armenia, Russia), rilpivirine (Russia), long-acting rilpivirine, islatravir, lenacapavir (EAPO); sofosbuvir (Russia); molnupiravir (EAPO, Russia), nirmatrelvir (EAPO); pretomanid in bedaquiline/pretomanid/linezolid regimen, pretomanid granulate, pretomanid amorphous form (EAPO), bedaquiline (Belarus, Kazakhstan, Kyrgyzstan). EECA communities developed expertise on patent challenges, successfully opposed patents, and revealed and addressed systemic barriers to CSO engagement in access-related IP work. The programme has potential for expansion, as demonstrated by a CBO opposition in Uzbekistan in December 2025 (delamanid). Results from the structural barrier analysis call for legal reform to enhance community involvement in mitigating IP barriers and improving access to medicines."

Hepatitis C • Hepatology • Human Immunodeficiency Virus • Infectious Disease • Inflammation • Novel Coronavirus Disease • Respiratory Diseases • Tuberculosis

In silico study: ADMET-driven pharmacokinetic profiling of antiviral compounds for pre-clinical screening framework of intranasal drug development. (PubMed, J Pharmacol Toxicol Methods) - "This study employed computational ADMET Predictor tools to systematically evaluate the physicochemical and potential pharmacokinetic properties of ten reference compounds, including nine approved antiviral drugs and ivermectin, a repurposed antiparasitic agent with reported antiviral activity and prior intranasal investigation: Zanamivir, Ribavirin, Oseltamivir, Favipiravir, Remdesivir, Nitazoxanide, Acyclovir, Lopinavir, Molnupiravir, and Ivermectin...The analysis resulted in revised criteria including molecular weight (Mwt), pH, lipophilicity (Log P), water solubility (Sw and SpH), Volume of distribution (Vd), P-glycoproteins substrate (Pgp substrate), and skin sensitization (Sens_Skin) to demonstrate 80% concordance with approved drug properties. This framework provides the preliminary evidence-based screening criteria as a tool to identify promising drug candidates suitable for preclinical evaluation in intranasal formulation development."

Journal • PK/PD data • Preclinical • Developmental Disorders • Infectious Disease • Influenza • Novel Coronavirus Disease • Respiratory Diseases • Respiratory Syncytial Virus Infections

Cracking the code to remove patent barriers (AIDS 2026) - "Overall, 25 of these PO templates were used to file 59 POs, including six oppositions using the nirmatrelvir/ritonavir template; and five oppositions each, on lenacapavir, doravirine and molnupiravir templates. The MMA experience demonstrates that, despite the complex technical aspect of POs, local CS and CBOs are able to file successful cases; 38% of POs filed by MMA members were successful, while 43% are in process. PO templates enabled the filing of additional patent oppositions on prioritized medicines across multiple countries."

Human Immunodeficiency Virus • Infectious Disease

Comparison of the permeability of RdRp inhibitors, remdesivir, molnupiravir and azvudine, in placental barrier cell models and exploration of their transport mechanisms. (PubMed, J Antimicrob Chemother) - "RDV and GS-441524 displayed low placental permeability in BeWo cells, whereas EIDD-1931 and azvudine displayed high permeability. Multiple ENTs, CNTs, OAT4, P-gp and BCRP might be involved in placental transport of RDV, GS-441524, EIDD-1931 and azvudine. These findings offer new insights into the placental transport of RdRp inhibitors during pregnancy."

Clinical • Journal • Breast Cancer • Infectious Disease • Novel Coronavirus Disease • Oncology • Respiratory Diseases • Solid Tumor • SLC29A1

Identification of (20R)-protopanaxadiol from Panax ginseng as a novel anti-SARS-CoV-2 compound. (PubMed, FEBS Open Bio) - "Replication was inhibited by remdesivir, nirmatrelvir, and molnupiravir, but not by favipiravir or AT-527. A screening of 373 food-derived compounds identified (20R)-protopanaxadiol (PPD), a ginseng metabolite, as a novel inhibitor. Together, this work highlights this BAC-vectored replicon as a practical platform for antiviral screening and identifies the potential of safe, food-derived supplements in combating SARS-CoV-2."

Journal • Infectious Disease • Novel Coronavirus Disease • Respiratory Diseases

MOLCOVred: Molnupiravir and COVID-19 Mortality Reduction in the Omicron Era (clinicaltrials.gov) - P=N/A | N=1814551 | Completed | Sponsor: Charles University, Czech Republic

New trial • Real-world evidence • Infectious Disease • Novel Coronavirus Disease • Respiratory Diseases

Serum albumin nanoparticle systems for encapsulation and sustained release of antiviral drugs. (PubMed, J Microencapsul) - "In the present study, bovine serum albumin (BSA) nanoparticles were prepared using desolvation method and explored as carriers for antiviral drugs like remdesivir, molnupiravir, hydroxychloroquine, and daclatasvir. Encapsulation efficiency remained nearly constant across formulations F-1 to F-4, suggesting early saturation of drug-protein interaction sites and efficient loading at lower BSA levels. Results from formulation F-2 indicated that drug release patterns were influenced more by the intrinsic physicochemical characteristics of the drug than by nanoparticle characteristics."

Journal • Infectious Disease • Novel Coronavirus Disease

Dual prodrugs of N4-hydroxycytidine with ProTide and ester modifications as anti-SARS-CoV-2 agents. (PubMed, Eur J Med Chem) - "Molnupiravir, an oral prodrug of β-D-N4-hydroxycytidine (NHC), is a broad-spectrum antiviral agent...Furthermore, pharmacokinetic evaluations revealed a tunable profile: 4 demonstrated significantly enhanced metabolic stability in human plasma, suggesting its potential as a long-circulating systemic reservoir, whereas 5b displayed favorable in vitro antiviral activity, likely associated with its balanced physicochemical properties and rapid esterase-mediated conversion to the more plasma-stable ProTide intermediate 4. Consequently, these findings demonstrate prodrugs 4 and 5b represent promising antiviral agents with favorable metabolic stability and high potency."

Journal • Infectious Disease • Novel Coronavirus Disease • Respiratory Diseases

Association of oral outpatient antiviral medications for COVID-19 with the risk of post-acute sequelae of COVID-19 at 28 and 90 days in a cohort of individuals with systemic autoimmune rheumatic diseases. (PubMed, Clin Rheumatol) - "In this contemporary cohort, risk of PASC 90 days after COVID-19 onset was overall low. Those who received antiviral therapy had similar odds of PASC at 28 days and numerically lower odds of PASC at 90 days compared to those who did not receive antivirals, providing evidence to quantify PASC risk when considering oral outpatient antiviral treatment. Key Points • Among people with rheumatic diseases, post-acute sequelae of COVID-19 (PASC) status at 28 days after symptom onset was similar regardless of antiviral use. • Odds of PASC at 90 days were numerically lower with antiviral use. • Patient-reported outcomes were similar regardless of antiviral use."

Journal • Immunology • Infectious Disease • Inflammatory Arthritis • Novel Coronavirus Disease • Rheumatology

Randomized, Double-Blind, Placebo-Controlled First-in-Human Trial of a First-in-Class AI-Designed Monoclonal Antibody (GB-0669) Against the Conserved SARS-CoV-2 Spike S2 Stem Helix. (PubMed, J Infect Dis) - "The data support exploring GB-0669 at 1200 mg in a Phase 2 trial for treating COVID-19 in immunocompromised individuals. The combination of GB-0669 with antiviral drugs may offer additional therapeutic benefits."

Clinical • First-in-human • Journal • P1 data • Infectious Disease • Novel Coronavirus Disease • Respiratory Diseases