Nirmatrelvir and molnupiravir maintain potent in vitro and in vivo antiviral activity against circulating SARS-CoV-2 omicron subvariants

Antiviral Res. 2024 Oct:230:105970. doi: 10.1016/j.antiviral.2024.105970. Epub 2024 Jul 25.

Abstract

Variants of SARS-CoV-2 pose significant challenges in public health due to their increased transmissibility and ability to evade natural immunity, vaccine protection, and monoclonal antibody therapeutics. The emergence of the highly transmissible Omicron variant and subsequent subvariants, characterized by an extensive array of over 32 mutations within the spike protein, intensifies concerns regarding vaccine evasion. In response, multiple antiviral therapeutics have received FDA emergency use approval, targeting the SARS-CoV-2 RNA-dependent RNA polymerase (RdRp) and main protease (Mpro) regions, known to have relatively fewer mutations across novel variants. In this study, we evaluated the efficacy of nirmatrelvir (PF-07321332) and other clinically significant SARS-CoV-2 antivirals against a diverse panel of SARS-CoV-2 variants, encompassing the newly identified Omicron subvariants XBB1.5 and JN.1, using live-virus antiviral assays. Our findings demonstrate that while the last Omicron subvariants exhibited heightened pathogenicity in our animal model, nirmatrelvir and other clinically relevant antivirals consistently maintained their efficacy against all tested variants, including the XBB1.5 subvariant.

Keywords: 3CLpro; Animal models; Mpro; Nirmatrelvir; SARS-CoV-2; VOC.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenosine Monophosphate / analogs & derivatives
  • Adenosine Monophosphate / pharmacology
  • Adenosine Monophosphate / therapeutic use
  • Alanine / analogs & derivatives
  • Alanine / pharmacology
  • Animals
  • Antiviral Agents* / pharmacology
  • Antiviral Agents* / therapeutic use
  • COVID-19 / virology
  • COVID-19 Drug Treatment*
  • Chlorocebus aethiops
  • Cytidine / analogs & derivatives
  • Cytidine / pharmacology
  • Cytidine / therapeutic use
  • Humans
  • Hydroxylamines* / pharmacology
  • Hydroxylamines* / therapeutic use
  • Lactams
  • Leucine
  • Mice
  • Mutation
  • Nitriles
  • Proline
  • SARS-CoV-2* / drug effects
  • SARS-CoV-2* / genetics
  • Spike Glycoprotein, Coronavirus / genetics
  • Vero Cells

Substances

  • Antiviral Agents
  • molnupiravir
  • Hydroxylamines
  • nirmatrelvir
  • Cytidine
  • Adenosine Monophosphate
  • Spike Glycoprotein, Coronavirus
  • Alanine
  • Lactams
  • Leucine
  • Nitriles
  • Proline

Supplementary concepts

  • SARS-CoV-2 variants