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Comment by fredliu | Hacker News Reader

> As a protease inhibitor, Paxlovid is free from the theoretical DNA-alteration risk tied to the mechanism of action of Merck’s molnupiravir.

This is the line I was looking for. Not that I know how protease inhibitor works, but looks more like a traditional anti-viral approach v.s. the potentially DNA altering molnupiravir.

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In brief, coronaviruses make all their proteins as one long chain and then cut it up into the appropriate pieces to form the proteins (spike etc). 3CL protease is the cutting machine and Paxlovid inhibits that.

It also means it’s going to be very difficult for the virus to be able to mutate to evade this. The protease is the beating heart.

It's interesting to learn about. Other molecules are also found to inhibit replication of 3CL protease in SARS cov-2 [1].

The UK scientific advisory group SAGE published a few months ago that combination therapy might be useful to avoid 'antiviral resistant' strains of SARS cov-2 evolving. Perhaps these 3cl protease inhibitors may be used in combination.

[1] https://www.nature.com/articles/s42003-020-01577-x

Whoa, well spotted, and good news!

When I first read about molnupiravir's mode of action, my gut reaction was "cancer in a pill, no thanks"

I doubt we’ll see molnupiravir getting approved in this context now. I think the mechanism just has too much risk.

Already approved in the UK:

https://www.bbc.com/news/health-59163899

Unfortunately in the UK there has been political pressure to do absolutely anything (no matter how questionable - e.g challenge trials) that isn't imposing even the slightest restriction.

Rolling review for the EU is underway. Let's wait how it turns out.

https://www.ema.europa.eu/en/news/covid-19-ema-starts-rollin...

The UK is very different from the US. They seem hell-bent on approving everything. Even historically (thalidomide).

Are you a pharmaceutical research scientist?

Do I need to be to have an opinion?

You seem awfully confident in your opinion for not having any deep knowledge of the area.

Ad hominem attack

Lol, no.

Calling out the OP for being wrong and them admitting they have no knowledge in the area is not an ad hominem attack.

The OPs theory was disproven on its merits alone.

To have a qualified opinion that carries any weight, yes.

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