The World Health Organisation (WHO) has updated its living guidelines on COVID-19 therapeutics to include a conditional recommendation on molnupiravir, a new antiviral medicine.

This is the first oral antiviral drug to be included in the treatment guidelines for COVID-19. As this is a new medicine, there is little safety data. WHO recommends active monitoring for drug safety, along with other strategies to mitigate potential harms.

The recommendation is based on new data from six randomised controlled trials involving 4796 patients. This is the largest dataset on this drug so far. Along with a recommendation on molnupiravir, this ninth update of WHO’s living guideline on therapeutics includes an update on casirivimab-imdevimab, a monoclonal antibody cocktail. Based on evidence that this combination of drugs is ineffective against the Omicron variant of concern, WHO now recommends that it is only given when the infection is caused by another variant.

Molnupiravir is not widely available but steps have been taken towards increasing access, including the signing of a voluntary licensing agreement. The Access to COVID-19 Tools Accelerator (ACT-A) is making a limited supply available to countries with access constraints.

WHO has also invited manufacturers to submit the products for prequalification, with several manufacturers of molnupiravir going through assessment now.