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Ratutrelvir is an investigational oral small molecule inhibitor of the SARS-CoV-2 main protease (Mpro or 3CL protease), developed as a broadly acting antiviral treatment for COVID-19. Unlike nirmatrelvir (the active component of Paxlovid), ratutrelvir does not require co-administration with ritonavir, thereby reducing the risk of drug-drug interactions and potentially enabling wider patient use. Preclinical studies have shown that ratutrelvir is highly active against native SARS-CoV-2 virus, nirmatrelvir-resistant strains, and multiple variants including omicron. In Phase 1 clinical trials, once-daily dosing maintained plasma concentrations well above the EC50 for viral inhibition and was well-tolerated without significant adverse events. The pharmacokinetic profile suggests it may reduce clinical rebound and lower the risk for long COVID by maintaining effective drug levels throughout treatment[2][4][5][7].
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