This is an unfortunately good point: will patient noncompliance on Molnupiravir treatment regimes bring on the viral-mutant problems that many have worried about? I haven't been as concerned about that, but this would be the way it could happen. . .https://twitter.com/zeynep/status/1467890223145172996 …
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Replying to @Dereklowe
I am certain we will get substantive levels of patient noncompliance, skipped doses, erratic timing, early stopping etc. and also re-targeting (left-over/hoarded pills being shared). I'd like some clarity on how that affects this tail risk—not to the patient but to society.
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Replying to @zeynep @Dereklowe
We have dealt with this issue before with TB. Standard therapy involves taking multiple antibiotics for 6 months. Gaps are a main driver of resistance. For this reason, directly observed therapy (DOT) is used to monitor compliance, supplemented w/PH law. https://www.health.ny.gov/publications/3705.pdf …
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Replying to @jallepap @Dereklowe
Yes, very aware of the comparison. A few key differences, no? The benefit to patient is unequivocal, and evolution occurs under a background rate of mutation—it's not like the antibiotics are mutagenic. But yes, obviously, even then, it is a problem.
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If the risk is like unleashing a "TB+" with R 6-8+ (like Delta) via single patient non-compliance, and we don't have antibiotics for the disease, a pre-approval seeking of clarity makes sense to me—at a minimum, what is the real efficacy? Recalls can be damaging to trust as well.
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I'm really interested in learning more about how the public can be reassured, and how there could be more clarity on the risk and what kind of measures could help minimize it.
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