Carolina research leads to experimental pill to treat COVID-19

(CHAPEL HILL, N.C., Updated Dec. 1, 2021) Scientists at the University of North Carolina at Chapel Hill say a twice-daily pill – molnupiravir — could change the way COVID-19 is treated. Advisors to the Food and Drug Administration have recommended emergency use authorization of the drug that was researched and tested at the UNC-Chapel Hill.

Clinical trial results showed the experimental COVID-19 pill reduced hospitalizations and deaths in people recently infected with coronavirus. UNC-Chapel Hill began working on molnupiravir in 2016 and demonstrated the drug could be a weapon against coronaviruses and future pandemics.

“This is a real game changer for a pandemic like COVID-19 because it allows us to treat people quicker with a method that’s convenient and accessible,” said William A. Fischer II, an associate professor of pulmonology and critical care at the UNC School of Medicine and director of emerging pathogens at the UNC Institute for Global Health and Infectious Diseases.

Fischer led a phase 2 clinical trial with Merck and Ridgeback Biotherapeutics that set the stage for further patient testing. If approved by the FDA, the first pill to treat COVID-19 could be available within weeks.

The UNC-Chapel Hill-led study revealed those who took molnupiravir at their first sign of COVID-19 symptoms cleared coronavirus faster than those in a placebo group. After five days, tests were unable to detect the virus in volunteers who took the antiviral pill twice a day.

Molnupiravir was discovered at Emory University and originally designed to fight flu. But animal testing at UNC Gillings School of Global Public Health, Vanderbilt University and Emory showed it blocked transmission of the virus that causes COVID-19 and reduced lung damage. The drug also inhibited coronavirus in recent studies at UNC School of Medicine using human lung cells.

Timothy Sheahan, a virologist at UNC Gillings School of Global Public Health and pioneer of antiviral drug research along with Ralph Baric, Kenan Distinguished Professor of Epidemiology at UNC-Chapel Hill, led a pivotal study of the broad-spectrum antiviral.

“We were the first to show it worked against lots of different coronaviruses in cells and culture and animal models of coronavirus disease,” Sheahan said. “The work that we did at Gillings School of Global Public Health demonstrated that molnupiravir was effective at stopping all the coronaviruses we tested in the lab including SARS-CoV-2, the virus that causes COVID-19, common cold-causing coronaviruses and emerging coronaviruses like SARS, and MERS.”

The oral antiviral drug works by preventing the virus from making copies of itself.

“Currently the approved antivirals to treat COVID-19 have to be injected so that limits rollout or access to those who are sick,” Sheahan said. “The power of an oral antiviral drug is to stop people from going to the hospital.”

Molnupiravir could fill an important role in preventing transmission and helping people who are sick, but still at home.

“If diagnosed with COVID-19, you could immediately go to the drugstore to pick up an antiviral. If it does its job correctly it should make you less sick and shorten the duration of the disease and prevent you from transmitting the virus to others in your household,” Sheahan said.

More than a year into the pandemic, and doctors and COVID-19 patients have few treatment options. Only one drug has been authorized for use: remdesivir, a treatment used to speed recovery that UNC-Chapel Hill identified as a potential COVID-19 treatment. Unlike remdesivir, which has to be given intravenously at a hospital, molnupiravir can be swallowed as a pill.

“At UNC-Chapel Hill we have really invested in the development of preclinical compounds that look good in cells and animals, but also extended that work into the clinical space so that we can identify compounds that are safe and effective before the next outbreak,” Fischer said. “This is work that’s happening every day at Carolina.”