Why molnupiravir, a COVID antiviral drug, is sitting on pharmacy shelves : Shots - Health News The antiviral pill molnupiravir was authorized and distributed by the government late last year. But it's not doctors' first choice of treatment, except for a narrow slice of patients.

Doctors find limited use for less effective COVID pill

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With omicron cases falling, U.S. officials say the country is moving towards a time when COVID isn't a crisis. Well, COVID treatments, especially for people with risk factors for serious illness, are essential to this plan. But one of the treatments in ample supply is not moving off the shelves. NPR's Pien Huang explains some of the reasons why.

PIEN HUANG, BYLINE: If you get COVID and you're at high risk for getting worse, there are two pills available that could reduce your risk of getting hospitalized. But these two pills are not equal. Paxlovid from Pfizer has been hard to find, while molnupiravir from Merck is plentiful. In fact, Dr. Derek Eisnor, who leads the government's distribution of COVID drugs, says the pills, which the U.S. government has spent $2.2 billion on, are piling up on pharmacy shelves.

DEREK EISNOR: We've received some feedback from some pharmacies that are running into issues with storage based on molnupiravir and are not moving the product that quickly.

HUANG: One of the main reasons it's not moving is that it's the least effective drug on the COVID treatment shortlist. According to data reviewed by the FDA, other treatments, like Paxlovid pills and antibody infusions, are 90% effective at preventing hospitalizations. Molnupiravir cuts those risks by just 30%, and the government recommends it only as a last resort. Dr. Rajesh Gandhi of Mass General Hospital says he and his colleagues aren't eager to prescribe it.

RAJESH GANDHI: I share that kind of general perception that it's an alternative rather than a first line drug, yeah. And I think that's why the utilization is lower.

HUANG: And molnupiravir comes with reproductive risks, which rules it out for most people trying to conceive. But those other, more effective treatments also have drawbacks. Paxlovid pills have a long list of common drugs you can't take with them. Antibody infusions require going to a clinic to get them. And many of those treatments are in short supply. So, Gandhi says, there's still a place for molnupiravir as an alternative when other drugs can't be given.

At Trillium Health, a community health center in Rochester, N.Y., Dr. Bill Valenti says he prefers the other treatments, too, but he's found a use for molnupiravir.

BILL VALENTI: We have a lot of complicated patients who have complex med lists whose drugs cannot always be discontinued.

HUANG: They've treated more than a dozen COVID patients with molnupiravir, including his patient John DeGrandis.

JOHN DEGRANDIS: I'm kind of his guinea pig (laughter) sometimes so - because we're friends. We're old friends. I've known Bill for years.

HUANG: The first time DeGrandis got COVID, it was before vaccines and treatments were available, and it felt like a really bad cold. This month, when he got it again, Dr. Valenti had options.

VALENTI: I think it's preferable to treat than not to treat. So went through the list...

HUANG: At the top of the list were Paxlovid pills, but Dr. Valenti ruled them out because they might have bad interactions with other medications DeGrandis was taking. Then there was a long waitlist for infusions, which would take a while to get. Valenti says that left molnupiravir, which isn't as effective.

VALENTI: On the other hand, maybe we can balance that out by giving it to him early in the course of his illness, giving it to him now.

HUANG: The whole point of early treatments is to stop the virus from spreading throughout the body. So DeGrandis filled his prescription at Walgreens and took four pills twice a day for five days. At the end of the course, did it help?

DEGRANDIS: I don't know the difference, you know, because I honestly have not felt bad the whole time. I mean, I was a little tired, but now I'm - I feel 100%.

HUANG: Valenti says new treatments that might be better are in the works.

VALENTI: These drugs are good for the time, especially since it took so little time to find something that was helpful, but I think this is just the beginning of the treatment era.

HUANG: For now, he'll work with what he's got.

Pien Huang, NPR News.

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