: FDA advisers to vote Tuesday on Merck’s COVID-19 pill even as interest has waned

If molnupiravir is authorized by the FDA in the coming weeks, as is expected, it will be the first oral COVID-19 pill during the pandemic that you can take at home.

Of the COVID-19 treatments that are currently available, most are used to care for very sick, hospitalized individuals. This includes the steroid dexamethasone and Gilead Sciences Inc.’s
GILD,
-0.79%
Veklury.

The monoclonal antibodies developed by Eli Lilly & Co.
LLY,
-2.74%,
Regeneron Pharmaceuticals Inc.
REGN,
-2.25%,
and Vir Biotechnology Inc.
VIR,
+16.72%
and GlaxoSmithKline
GSK,
-0.87%
can be used to treat people with mild or moderate cases of COVID-19, but these treatments have to be administered by an infusion in a clinical setting.

Molnupiravir was once held up as a game-changer in the course of the pandemic, but its importance has shifted as new data from the clinical trial came out and a competitor stepped up.

Wall Street’s interest in Merck’s pill began to wane earlier this month when Pfizer Inc.
PFE,
+1.59%
produced even more compelling results for its COVID-19 drug candidate, demonstrating that Paxlovid reduced the risk of hospitalization and death by a stunning 89% in a clinical trial. The company filed for emergency authorization in mid-November.

Then, last week, Merck shared that its pill reduced the risk of hospitalization and death by 30% in a clinical trial—and not 50%, as reported in the interim results. Now, factor in the growing concern around the world about the omicron variant and the continuing need for new and better treatments for COVID-19.

“Concerns over the new omicron variant are increasing expectations on the potential of Pfizer’s COVID-19 vaccine Comirnaty and updated data from Merck’s oral anti-viral molnupiravir are increasing expectations for Pfizer’s anti-viral Paxlovid,” Mizuho Securities analysts wrote on Monday.

Expect these points to arise during today’s Antimicrobial Drugs Advisory Committee. This is the first pandemic “appearance” by this committee, which will be tasked with voting on whether the benefits of molnupiravir outweigh the risks. The FDA will then deliver its final decision, likely before the end of the year.

The regulator often takes into account the recommendation of its advisory committees but is not required to do so. 

“The FDA’s advisory committee meeting next week is likely to take a cautious approach towards the medicine,” SVB Leerink analysts wrote on Friday. “Despite these reservations, molnupiravir is also likely to be approved, and demand is likely to exceed their 20 [million] course supply in 2022.”

Analysts were once over the moon about the sales potential of the first oral COVID-19 pill that works, predicting between $5 billion and $7 billion in sales next year alone. But the arrival of new efficacy data dragged down interest in both the drug and Merck’s stock.

Citi on Monday downgraded Merck’s stock to neutral, from buy, citing concerns about the company’s experimental HIV drug islatravir and molnupiravir. 

Merck is seeking authorization for molnupiravir in adults who have tested positive for the virus, are experiencing mild or moderate symptoms, and are at high risk for severe disease. 

The Phase 2/3, randomized, placebo-controlled, double-blind study only enrolled people who were unvaccinated; however, it’s unclear whether the pill could be used to treat vaccinated individuals with breakthrough infections if it is authorized. 

Molnupiravir has already been authorized for use in the U.K

Read more coverage about Merck and its COVID-19 pill: 

Merck stock dives after Citi downgrades on ‘high probability’ that HIV treatment will be abandoned

Merck’s COVID-19 pill could bring in up to $7 billion in sales next year

Why a pill you take at home could change the direction of the pandemic