geoffrey modest medical blogs

  A recent lab study found that the antiviral agent molnupiravir seems to be effective against the newest omicron subvariants (BQ.1.1 and XBB): see  covid omicron molnupravir effective NEJM2022  in dropbox, or DOI: 10.1056/NEJMc2214302 Background : -- there have been 3 sublineages of the initial omicron variant (B.1.1.529): BA.1, BA.2, and BA.5 (see second graph below)     -- the current ones that are the circulating the most in the US (and much of the world): BQ.1.1 (a subvariant of BA.5) and XBB (a BA.2 subvariant) and now on its ascendency     -- in fact, a recent article indicates XBB is becoming the dominant variant (and is already so in the Northeast), along with its own subsubvariants XBB.1 and XBB.1.5:  https://edition. pagesuite.com/popovers/ dynamic_article_popover.aspx? artguid=458fe1fe-e157-4442- aa54-105c127b7904  from the Boston Globe -- these variants have large numbers of important substitutions in the rece...

  An efficacy study of Merck's oral medication molnupirivir for the treatment of non-hospitalized high-risk patients with symptomatic Covid found a 30% reduction in hospitalizations, in the MOVe-OUT trial (see   covid molnupirivir nejm2021  in dropbox, or DOI: 10.1056/NEJMoa2116044).  for the FDA factsheet, see  https://www.fda.gov/media/155054/download   Details:  -- 1433 participants were randomized to molnupirivir (800 mg BID for five days) versus placebo, begun within five days of the onset of symptoms, in an international study -- median age 42 (range 18-90)/34% > 50yo, 51% female --  all were unvaccinated adults  with mild to moderate laboratory-confirmed Covid tested no more than five days earlier, and had at least one risk factor for severe Covid:  age >60, active cancer, CKD, COPD, obesity, serious heart conditions, or diabetes:       -- obesity: 74%      -- >60yo: 17%   ...