Fourth-quarter (Q4) 2021 forecast sales of Merck & Co’s Covid-19 oral antiviral, molnupiravir, have seen a phenomenal increase from its third-quarter (Q3) forecasts, with increases of 17,500% and 7,986% for this year and next year respectively. Molnupiravir is currently the leading Covid-19 therapeutic by forecast sales and is expected to generate $14.7bn in sales from 2021 to 2025 driven by high forecast sales from 2021–22, according to GlobalData’s Coronavirus Disease 2019 (Covid-19) Sector Forecast: Q4 2021 Global Analyst Consensus Sales report.

Molnupiravir is currently the first approved oral antiviral Covid-19 therapeutic on the market, approved by the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) on 4 November by emergency use authorisation (EUA). Developed by Merck and Ridgeback Biotherapeutics, the drug is a ribonucleoside analogue that acts as an antiviral agent. It is formulated as hard capsules for oral administration and is indicated for the treatment of mild to moderate Covid-19 in adults who have at least one risk factor for developing severe illness.

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According to the Coronavirus Disease 2019 (Covid-19) Sector Forecast: Q4 2021 Global Analyst Consensus Sales report, the Q4 2021 forecast for molnupiravir saw the forecast sales for 2021 and 2022 increase by $4.4bn and $8.1bn respectively. Overall, molnupiravir’s Q4 2021 forecast has seen an average increase of 3,747% compared to its previous Q3 2021 forecast in September and saw large increases in forecast sales in five out of the seven forecast years, as indicated in Figure 1. This increase has led to molnupiravir’s forecast sales between last year and 2027 increasing exponentially from forecast sales of $1.4bn in the Q3 forecast to $14.7bn in the Q4 forecast.

This huge increase in forecast sales has been precipitated by the EUA awarded to molnupiravir by the UK’s MHRA, making it the first oral antiviral therapeutic approved for Covid-19. This is coupled with its oral route of administration, which has been hailed as a game-changer for possible at-home administration, which may lessen pressure on hospitals and healthcare providers as current Covid-19 therapeutics such as Veklury and REGN-COV2 require professional administration. This is of particular importance considering the increase in Covid-19 infections during this winter period, as well as the increase in breakthrough infections among vaccinated people.

Despite this surge in its forecast sales, there are concerns that the data available at the time of the forecast may be optimistic, considering that more recent analysis was published showing that molnupiravir’s ability to reduce the risk of hospitalisation or death by half—as originally thought—is in fact 20% less, providing only a 30% reduction. Pfizer’s oral antiviral Paxlovid has currently been shown to reduce the risk of hospitalisation by 89%; despite being first to market, molnupiravir may struggle to match these impressive sales forecasts in the face of competition.