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In high-risk outpatients with mild to moderate COVID-19, nirmatrelvir/ritonavir (Paxlovid) is the preferred therapy. However, some patients cannot take nirmatrelvir/ritonavir because of drug interactions with their other medications. Now, a study in China shows promising results with an oral remdesivir analogue, VV116.
A total of 771 patients with mild-to-moderate COVID-19 at high risk for progression were randomized to receive 5 days of oral VV116 or nirmatrelvir/ritonavir. About 75% of participants had received COVID-19 vaccination. VV116 was non-inferior to nirmatrelvir/ritonavir regarding time to sustained clinical recovery. Median time to COVID-19 symptom resolution was 7 days in both groups. No participant died or progressed to severe COVID-19. Altered taste was reported by 3.6% of the VV116 group and 25.8% of the nirmatrelvir/ritonavir group.
Cao Z et al. VV116 versus nirmatrelvir–ritonavir for oral treatment of Covid-19. N Engl J Med 2022 Dec 28; [e-pub]. (https://doi.org/10.1056/NEJMoa2208822)
Comment
This trial suggests that an oral remdesivir analogue, VV116, yields clinical outcomes comparable to those of nirmatrelvir/ritonavir. However, because the trial lacked a placebo group and no participant progressed to severe disease, it's not possible to draw definitive conclusions about this investigational drug. Nevertheless, I am excited to see the results of ongoing clinical trials with other oral remdesivir analogues. We need a highly efficacious oral treatment option for patients who cannot receive nirmatrelvir/ritonavir.