Thread by @vipintukur

No doubt, #molnupiravir is touted as a ‘game changer’ as far as therapeutics against #SARS2 are concerned. But the news related to its probable #mutagenic potential comes as a dampener 1/

https://twitter.com/cnbc/status/1444077164215820288

#rNHC, an active metabolite of #Molnupiravir, inhibits SARS2 replication in cell cultures through lethal mutagenesis, but is also mutagenic to mammalian host cells 2/

Read this paper👇
academic.oup.com/jid/article/22…

#rNHC has powerful in vitro and in vivo activity against a large number of highly pathogenic emerging RNA viruses and represents a potentially important drug for use in the current and future pandemics. 3/

However, the risks for the host may not be zero and these risks need to be carefully evaluated in undertaking therapies that are by their nature designed to change the coding capacity of a virus’ genetic material. 4/

So, evaluating the utility of #molnupiravir should be done in those likely to receive the greatest benefit with monitoring provided to assess potential long-term genotoxic side effects. 5/

Dose is going to be the key! Substitution error increases in a dose dependent fashion.
We need to limit the duration of the entire course of treatment. Probably a single shot regimen for those at high risk, but figuring the risk-benefit ratio is going to be tricky 6/