Nature News on Covid drugs: overview and new trends

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Over the past two years, the ACTIV programme, run by the US National Institutes of Health (NIH), has included more than 30 studies — 13 of them ongoing — of therapeutic agents chosen from a list of 800 candidates. Several of the studies are due to report results in the first half of the year. And that’s just in his programme; hundreds more are in progress around the world.

Researchers have developed a handful of options — including two oral antiviral drugs, Paxlovid and molnupiravir, authorized in some countries in the past couple of months — that help in certain situations. But gaps remain, and researchers think that this year will bring new drugs and new uses for older drugs, including better treatments for mild COVID-19.

The antiviral drug remdesivir (Veklury), made by Gilead Sciences in Foster City, California, is given as an infusion, and so was reserved, until recently, only for people hospitalized with COVID-19. (On 21 January, the US Food and Drug Administration (FDA) authorized remdesivir for outpatient treatment of people at high risk of COVID-19 complications.)

Bursting pipeline: bar chart that shows the number of therapies for COVID-19 that are in development or have failed.
Source: BIO COVID-19 Therapeutic Development Tracker

Several firms have developed monoclonal antibodies — mass-produced versions of the neutralizing antibodies that the immune system pumps out to bind to and disable SARS-CoV-2. These therapies offered another early route to treatment, and more than 200 monoclonal antibodies are now under development or authorized. But they are expensive compared with other treatments, are in short supply, and often have to be infused.

With time, the focus began to shift to drugs that could be used outside a hospital setting to treat mild illness, in the hope of preventing progression to more severe disease. In late 2021, two antiviral treatments — Lagevrio (molnupiravir), developed by Merck, based in Kenilworth, New Jersey, and Ridgeback Biotherapeutics in Miami, Florida; and Paxlovid (a combination of two drugs, nirmatrelvir and ritonavir), developed by Pfizer, based in New York City — became available as pills that could be taken at home.

Read more:

Nature 603, 25-27 (2022)


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