» Articles » PMID: 36060104

The History, Mechanism, and Perspectives of Nirmatrelvir (PF-07321332): an Orally Bioavailable Main Protease Inhibitor Used in Combination with Ritonavir to Reduce COVID-19-related Hospitalizations

Overview
Journal Med Chem Res
Publisher Springer
Specialty Chemistry
Date 2022 Sep 5
PMID 36060104
Authors
Affiliations
Soon will be listed here.
Abstract

The rapid development of effective vaccines to combat the SARS-CoV-2 virus has been an effective counter measure to decrease hospitalization and the mortality rate in many countries. However, with the risk of mutated strains decreasing the efficacy of the vaccine, there has been an increasing demand for antivirals to treat COVID-19. While antivirals, such as remdesivir, have had some success treating COVID-19 patients in hospital settings, there is a need for orally bioavailable, cost-effective antivirals that can be administered in outpatient settings to minimize COVID-19-related hospitalizations and death. Nirmatrelvir (PF-07321332) is an orally bioavailable M (also called 3CL) inhibitor developed by Pfizer. It is administered in combination with ritonavir, a potent CYP3A4 inhibitor that decreases the metabolism of nirmatrelvir. This review seeks to outline the history of the rational design, the target selectivity, synthesis, drug resistance, and future perspectives of nirmatrelvir. Graphical abstract.

Citing Articles

Design of quinoline SARS-CoV-2 papain-like protease inhibitors as oral antiviral drug candidates.

Jadhav P, Liang X, Ansari A, Tan B, Tan H, Li K Nat Commun. 2025; 16(1):1604.

PMID: 39948104 PMC: 11825904. DOI: 10.1038/s41467-025-56902-x.


Distal protein-protein interactions contribute to nirmatrelvir resistance.

Lewandowski E, Zhang X, Tan H, Jaskolka-Brown A, Kohaal N, Frazier A Nat Commun. 2025; 16(1):1266.

PMID: 39893201 PMC: 11787374. DOI: 10.1038/s41467-025-56651-x.


Research Progress on the Structure and Function, Immune Escape Mechanism, Antiviral Drug Development Methods, and Clinical Use of SARS-CoV-2 M.

Ren J, Zhang Z, Xia Y, Zhao D, Li D, Zhang S Molecules. 2025; 30(2).

PMID: 39860219 PMC: 11767629. DOI: 10.3390/molecules30020351.


Dual Inhibitors of SARS-CoV-2 3CL Protease and Human Cathepsin L Containing Glutamine Isosteres Are Anti-CoV-2 Agents.

Kumar V, Zhu J, Chenna B, Hoffpauir Z, Rademacher A, Rogers A J Am Chem Soc. 2025; 147(2):1631-1648.

PMID: 39746101 PMC: 11744766. DOI: 10.1021/jacs.4c11620.


A cell-based Papain-like Protease (PLpro) activity assay for rapid detection of active SARS-CoV-2 infections and antivirals.

Jimenez-Campos A, Maestas L, Velappan N, Beck B, Ye C, Wernsing K PLoS One. 2024; 19(12):e0309305.

PMID: 39724215 PMC: 11670956. DOI: 10.1371/journal.pone.0309305.


References
1.
Heskin J, Pallett S, Mughal N, Davies G, Moore L, Rayment M . Caution required with use of ritonavir-boosted PF-07321332 in COVID-19 management. Lancet. 2022; 399(10319):21-22. PMC: 8718360. DOI: 10.1016/S0140-6736(21)02657-X. View

2.
Schooley R, Carlin A, Beadle J, Valiaeva N, Zhang X, Clark A . Rethinking Remdesivir: Synthesis, Antiviral Activity, and Pharmacokinetics of Oral Lipid Prodrugs. Antimicrob Agents Chemother. 2021; 65(10):e0115521. PMC: 8448143. DOI: 10.1128/AAC.01155-21. View

3.
Tan J, George S, Kusov Y, Perbandt M, Anemuller S, Mesters J . 3C protease of enterovirus 68: structure-based design of Michael acceptor inhibitors and their broad-spectrum antiviral effects against picornaviruses. J Virol. 2013; 87(8):4339-51. PMC: 3624371. DOI: 10.1128/JVI.01123-12. View

4.
Martin J, Mackenzie C, Fletcher D, Gilbert I . Characterising covalent warhead reactivity. Bioorg Med Chem. 2019; 27(10):2066-2074. PMC: 6538824. DOI: 10.1016/j.bmc.2019.04.002. View

5.
Korkmaz B, Lesner A, Wysocka M, Gieldon A, Hakansson M, Gauthier F . Structure-based design and in vivo anti-arthritic activity evaluation of a potent dipeptidyl cyclopropyl nitrile inhibitor of cathepsin C. Biochem Pharmacol. 2019; 164:349-367. DOI: 10.1016/j.bcp.2019.04.006. View