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Molnupiravir, an oral antiviral against SARS-CoV-2: Chris Butler, ECCMID 2023

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Published Online: Apr 21st 2023

Molnupiravir, an oral antiviral against SARS-CoV-2 was first granted emergency use authorisation in 2021 to reduce the risk of hospitalisation and death in mild to moderate COVID-19 with increased risk of developing severe disease. We were delighted to speak with Prof. Chris Butler (University of Oxford, Oxford, UK) to discuss the mechanism of action of molnupiravir and the impact the UK approval has already had on the COVID-19 pandemic response.

Catch up: Interview with Prof. Chris Butler highlights the PANORAMIC study results, and how these insights will optimise the use of molnupiravir in clinical practice

The abstract ‘Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): findings from the United Kingdom randomised, controlled open-label, platform adaptive trial.‘ (Abstract number: O1118) was presented at ECCMID 2023, 15-18 April, 2023, Copenhagen, Denmark.


  1. What is the mechanism of action of molnupiravir and why is it indicated in early stages of infection? (0:22)
  2. What impact has the UK approval of molnupiravir already had on the COVID-19 pandemic response? (1:07)

Disclosures: Chris Butler discloses being the Chief Investigator of the NIHR funded PRINCIPLE and PANORAMIC trials of community treatment for COVID.

Support: Interview and filming supported by Touch Medical Media Ltd. Interview conducted by Katey Gabrysch and Victoria Jones.

Filmed in coverage of the 33rd European Congress of Clinical Microbiology & Infectious Diseases.

Click here for more content on COVID-19 & for further ECCMID 2023 highlights visit here.


What is the mechanism of action of molnupiravir and why is it indicated in early stages of infection? (0:22)

The drug works by putting the molecules into the virus’s way. That, in a way, tricks the virus to think that these chemicals are actually part of the building blocks of its nucleic acid and so it puts the wrong sort of building block into its genetic material so that when it tries to replicate, there’s what we call catastrophic mutations in the virus and it can’t replicate anymore and becomes non-infective.

What impact has the UK approval of molnupiravir already had on the COVID-19 pandemic response? (1:07)

In a way, I’m really proud of the way the UK has handled the rollout of novel antiviral agents. And it’s worth reflecting for a minute on what we did with antibiotics, because in a way with antibiotics we proceeded on the basis of what you might call assumption based medicine. Where we found penicillin good for pneumonia, and therefore we thought, it’s got to be good for coughs and therefore it’s got to be good for earaches and snotty noses. We didn’t do the trials in what we call the intended use population. We used the drugs without doing the trials. We’re doing the trials now and we figured out that most people do not benefit from these antibiotics with those conditions. So we’re in the problem of the kind of parallel pandemic, if you like, of anti-microbial resistance. When the new antivirals became available, the UK government bought them. It said, look, let’s not just give them to everybody because there was a lot of people with COVID. Let’s do a trial and find out who’s going to benefit and who isn’t and that’s where the panoramic trial came in. And we’ve been using these drugs in the very highest risk groups, and the panoramic trial has been sort of figuring out whether the threshold for using them should be lowered and who, in fact, will benefit and who won’t. So we haven’t gone straight to widespread use of these drugs in the UK and it’s evidence based deployment that the country is following.

Subtitles and transcript are autogenerated.

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