Antiviral for the treatment of Covid arrives at clinics and pharmacies from this week

The antiviral molnupiravir begins to arrive this week in pharmacies and private clinics in Brazil. Produced by the pharmaceutical company MSD under the trade name Lagevrio, it was approved in Brazil for the treatment of adult patients with mild or moderate Covid-19, who are not hospitalized, who do not require supplemental oxygenation and who are at high risk of worsening the disease.

According to the company, the oral antiviral will be available in hospitals, oncology clinics and pharmacies that have already expressed interest in acquiring the product. The sale requires a medical prescription and the estimate is that the treatment will cost the consumer, on average, R$ 1,700.

Anvisa (National Health Surveillance Agency) approved the emergency use of the antiviral for adults at risk of disease progression in May and later the product was evaluated by Conitec (National Commission for the Incorporation of Technologies in the Unified Health System), which studied possible benefits and impacts of its inclusion in the SUS.

In their report, the review team states that the drug “likely reduces the risk of hospitalization or death in patients with mild to moderate Covid-19 who are at risk of disease worsening”, but the “absolute effect is modest and significantly lower than of another drug already incorporated for the same indication”.

Preliminary data from a trial carried out in the UK with more than 25,000 people suggest that the antiviral could speed up the patient’s recovery time, but would not reduce hospitalizations.

The Conitec report is based on a phase three clinical trial of 1,433 unvaccinated patients with at least one risk factor for disease worsening. Participants were divided into two groups, one that received a placebo and the other that received 800 mg of molnupiravir twice daily for five days. The risk of hospitalization or death in the molnupiravir group was 6.8% versus 9.7% in the placebo group.

The team also mentions that the systematic review published by the WHO (World Health Organization) in March showed a reduction of 43 hospitalizations per thousand patients treated with molnupiravir compared to placebo, evidence that was classified as moderate certainty. In the case of mortality, molnupiravir would prevent six deaths per 1,000 patients, evidence classified as low certainty.

As for the economic analysis of incorporation into the SUS, Conitec compared molnupiravir to nirmatrelvir/ritonavir —a drug recently incorporated into the SUS for the same indication—and concluded that it was a technology that would result in higher cost and lower effectiveness.

Based on the assessment, Conitec recommended not incorporating it into the SUS. The opinion may be reassessed if new facts are presented capable of altering the result of the analysis.