Thank you @LauermanJohn for revealing the untold origin story for Pfizer's Paxlovid COVID-19 pill.

The interesting part: Merck's drug boceprevir provided an essential backbone structure for Paxlovid, and boceprevir is still under patent.

bloomberg.com/news/articles/…
The article reveals many things not publicly known earlier.

First, Merck had (like my own lab and others) found boceprevir to have some activity against SARSCoV2. Not too surprising, as boceprevir is a HCV protease inhibitor, and SARSCoV2 protease is homologous to HCV protease.
I had emailed Merck to let them know in case they didn't already. But I expected the to know, and this confirms it. They determined that is was unlikely to work well for COVID19 on its own, but Merck was in a good position to modify it to work better, but they didn't.
There's an interesting quote from George Njoroge, the developer of boceprevir, regarding Merck's inaction: "I thought they would jump into it... I was a bit surprised"
Instead Pfizer took the ball and ran with it. Paxlovid (L) copied the crucial central portion of boceprevir (R) bond by bond over 22 atoms. The ends are also altered to work better on SARSCoV2, which is also crucial. But Pfizer papers and documents never mention boceprevir.
I'm quoted in the article pointing out that the idea for this structure in Paxlovid clearly came from boceprevir (it does not resemble anything from Pfizer's previous work in any way).

Anyway so now I probably have 2 big pharmas annoyed at me.

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More from @michaelzlin

Feb 4
Today in Science, two prominent viral drug experts express concerns about molnupiravir, Merck's mutagenic COVID pill:
1. Mutating patient DNA not ruled out
2. Mutating viral genomes for sure, risk unknown

Common theme: We're gambling when using this drug

science.org/doi/10.1126/sc…
Raymond Schinazi is a well known antiviral drug developer, called the "King of the Pills". His wikipedia page lists the many marketed HIV and HCV drugs he has developed based on nucleoside analogues like molnupiravir.
science.org/doi/10.1126/sc…
In fact Schinazi is the one person who has the most knowledge of molnupiravir (MOV). He's been studying its active metabolite NHC as an antiviral since 2003 (PMID 12499198). He didn't push it to clinic because of mutagenesis concerns. That comes out clearly above, but also below Image
Read 7 tweets
Feb 2
A recent study by Novavax suggests it may be able to provide broader protection across variants than other vaccines so far. That has interesting implications for vaccine design, if true.

This seems to have escaped analysis entirely, so we'll take a look.

medrxiv.org/content/10.110…
The study came out on 12/25. It contains the data behind Novavax's 12/22 announcement that 3 shots of their vaccine provided Omicron protection. That got into the news, but nobody came back on Christmas to write about the actual findings (I wonder why).
ir.novavax.com/2021-12-22-Nov…
Sorry, Novavax, but you might benefit from hiring a science communication consultant for advice on publication strategy and writing. Besides the poor decision to release your article on 12/25, assuring no one will analyze it, the abstract is a disaster. Because there isn't one.
Read 29 tweets
Feb 2
This study flew under the radar (only 1 news article): Omicron antibodies in participants of the NIH mix and match trial

Results: 3xRNA ~ 2xRNA+JJ ≥ JJ+RNA >> JJ+JJ

JJ+JJ ends up 10x worse than 3xRNA

medrxiv.org/content/10.110… @PaulSaxMD Image
Also confirms JJ is a poor booster for JJ, for either "original" D614G or Omicron. Image
Above, the JJ+Pfizer looked about 2x worse than 3xPfizer. Confidence intervals are wide, but another underreported Omicron study found JJ+Pfizer was ~3x worse than Mod+Mod+Pfizer. So this effect size seems consistent.

Great graphics BTW

medrxiv.org/content/10.110… Image
Read 11 tweets
Jan 31
🙄 Count on some "researchers" to claim the obvious answer isn't the answer.

Did we want a vax to the original strain? We did?

Is SARSCoV2 now mostly Omicron? It is?

Okay then...
Chances are nonzero that the next variant will come from the currently most widespread and most contagious variant, i.e. Omicron. Good to be prepared.
Basically in this epidemic, if the question is "should we .... just in case?" the answer is yes. Just do it.
Read 4 tweets
Jan 29
What's the diff between a chief librarian and a CDC director?

When a chief librarian leads his staff from a 1000mi away, it's a scandal.

When the CDC director does it during the deadliest pandemic ever, it's somehow not.

Yes, literally phoning it in.

seattletimes.com/entertainment/…
Well the director does fly in a few times a month. Is that enough time to see everything interesting from 10k staffers? Also doubt much reform/reorg is going to happen remotely

google.com/amp/s/time.com… Image
I expected the WH would had made willingness to move to Atlanta a precondition of appointment for the CDC director during our biggest loss of life ever, when access to info and good communication is more important than ever.
Read 8 tweets
Jan 25
If you haven't heard, FDA approved molnupiravir for COVID19. I've been concerned it could create highly mutated SARSCoV2 and make new enhanced viruses more likely. Today a new study supports the idea that letting viruses sample multiple mutations is risky.
It's already known that molnupiravir doesn't kill off all mutant viruses after 5 days, but does introduce mutations into the viral genome. That is after all its only mechanism of action. Some of the mutated viable viruses may then hop to other people.
The pro-MOV argument is that MOV drops levels of viable virus more than it increases mutations in the remaining viruses, which might mean fewer later mutational templates. For several reasons, these arguments are not convincing, which means we're making an unusually dangerous bet
Read 18 tweets

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