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Ensitrelvir is being studied for its potential use as post-exposure prophylaxis (PEP) after SARS-CoV-2 exposure. [19] [20] The SCORPIO-PEP trial is a global Phase 3 trial that will evaluate the safety and efficacy of the drug in preventing symptomatic SARS-CoV-2 infection in household contacts of people who tested positive for COVID-19.
The general idea behind modern antiviral drug design is to identify viral proteins, or parts of proteins, that can be disabled. [11] [13] These "targets" should generally be as unlike any proteins or parts of proteins in humans as possible, to reduce the likelihood of side effects and toxicity. [8]
Ribbon diagram of the protein with the drug shown as sticks. The catalytic residues (His41, Cys145) are shown as yellow sticks. The catalytic residues (His41, Cys145) are shown as yellow sticks. Nirmatrelvir is an antiviral medication developed by Pfizer which acts as an orally active 3C-like protease inhibitor .
A drug combination targeting SARS-CoV-2, Paxlovid, was approved in December 2021 to treat COVID-19. [12] It is a combination of nirmatrelvir , a protease inhibitor targeted to the SARS-CoV-2 3C-like protease , and ritonavir, which inhibits the metabolism of nirmatrelvir, thereby prolonging its effect.
The safety and efficacy of baloxavir marboxil, an antiviral drug taken as a single oral dose, was demonstrated in two randomized controlled clinical trials of 1,832 subjects where participants were assigned to receive either baloxavir marboxil, a placebo, or another antiviral flu treatment within 48 hours of experiencing flu symptoms. [7]
The drug was also shown to reduce the viral load at day 4 in treated patients compared to the placebo group. Side effects were mostly mild and infrequent, with the most common being nausea (1.5% vs. 0.2%) and skin rash (3.3% vs. 0.3%), which occurred more often in the olgotrelvir group.
Ritonavir is indicated in combination with other antiretroviral agents for the treatment of HIV-1-infected patients. [4] [5] [8] Though initially developed as an independent antiviral treatment, it is most commonly used as a pharmacokinetic enhancer, in order to increase the plasma concentrations of other antiretrovirals.
[42] [43] Neuropsychiatric symptoms and body pain, followed by skin problems, were identified as the side effects most significantly reducing patient satisfaction on a drug review platform. [ 44 ] The US and EU package inserts for oseltamivir contain a warning of psychiatric effects observed in post-marketing surveillance.