{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:54:22Z","timestamp":1791276862025,"version":"4.1.0"},"reference-count":43,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,8,13]],"date-time":"2023-08-13T00:00:00Z","timestamp":1691884800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>The COVID\u201019 pandemic, caused by severe acute respiratory syndrome coronavirus type 2 (SARS\u2010CoV\u20102), rapidly spread across the globe. Tremendous efforts have been mobilized to create effective antiviral treatment options to reduce the burden of the disease. This article summarizes the available knowledge about the antiviral drugs against SARS\u2010CoV\u20102 from a neurologist's perspective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We summarize neurological aspects of antiviral compounds against SARS\u2010CoV\u20102 with full, conditional, or previous marketing authorization by the European Medicines Agency (EMA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nirmatrelvir\/ritonavir targets the SARS\u2010CoV\u20102 3c\u2010like protease using combinatorial chemistry. Nirmatrelvir\/ritonavir levels are affected by medications metabolized by or inducing CYP3A4, including those used in neurological diseases. Dysgeusia with a bitter or metallic taste is a common side effect of nirmatrelvir\/ritonavir. Molnupiravir is a nucleotide analog developed to inhibit the replication of viruses. No clinically significant interactions with other drugs have been identified, and no specific considerations for people with neurological comorbidity are required. In the meantime, inconsistent results from clinical trials regarding efficacy have led to the withdrawal of marketing authorization by the EMA. Remdesivir is a viral RNA polymerase inhibitor and interferes with the production of viral RNA. The most common side effect in patients with COVID\u201019 is nausea. Remdesivir is a substrate for CYP3A4.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Neurological side effects and drug interactions must be considered for antiviral compounds against SARS\u2010CoV\u20102. Further studies are required to better evaluate their efficacy and adverse events in patients with concomitant neurological diseases. Moreover, evidence from real\u2010world studies will complement the current knowledge.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.16017","type":"journal-article","created":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T08:54:00Z","timestamp":1690880040000},"page":"3904-3912","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Neurological side effects and drug interactions of antiviral compounds against SARS\u2010CoV\u20102"],"prefix":"10.1111","volume":"30","author":[{"given":"Tamar","family":"Akhvlediani","sequence":"first","affiliation":[{"name":"Neolab Clinic  Tbilisi Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Bernard\u2010Valnet","sequence":"additional","affiliation":[{"name":"Neurology Service, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois) University of Lausanne  Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara P.","family":"Dias","sequence":"additional","affiliation":[{"name":"Department of Neurology Centro Hospitalar Universit\u00e1rio de Lisboa Central  Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randi","family":"Eikeland","sequence":"additional","affiliation":[{"name":"Department of Health and Nursing Sciences University of Agder  Grimstad Norway"},{"name":"Norwegian National Advisory Unit on Tick\u2010Borne Diseases S\u00f8rlandet Hospital Trust  Kristiansand Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina","family":"Pfausler","sequence":"additional","affiliation":[{"name":"Department of Neurology Medical University of Innsbruck  Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8749-5533","authenticated-orcid":false,"given":"Johann","family":"Sellner","sequence":"additional","affiliation":[{"name":"Department of Neurology Landesklinikum Mistelbach\u2010G\u00e4nserndorf  Mistelbach Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Infectious Disease Panel of the European Academy of Neurology","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,8,13]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14395"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-323-91532-8.00004-5"},{"key":"e_1_2_11_4_1","unstructured":"WHO.COVID\u201019 Weekly Epidemiological. Update Edition 1412023."},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41579-023-00878-2"},{"key":"e_1_2_11_6_1","unstructured":"CDC.COVID\u201019 Data Tracker Weekly Review: Interpretive Summary for April.2023."},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.o1431"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2021.101111"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciac724"},{"key":"e_1_2_11_10_1","unstructured":"EMA.https:\/\/www.ema.europa.eu\/en\/human\u2010regulatory\/overview\/public\u2010health\u2010threats\/coronavirus\u2010disease\u2010covid\u201019\/covid\u201019\u2010medicines.2023."},{"key":"e_1_2_11_11_1","unstructured":"EMA.https:\/\/www.ema.europa.eu\/en\/medicines\/human\/EPAR\/paxlovid.2022."},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-022-01692-5"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/MS9.0000000000000169"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2118542"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ohn.278"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/emph\/eoab031"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/odi.1431"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.2147\/TCRM.S3285"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2023.100694"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciac443"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.7326\/M22-2141"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.2646"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1080\/14656566.2022.2057795"},{"key":"e_1_2_11_24_1","unstructured":"FDA.https:\/\/www.fda.gov\/news\u2010events\/press\u2010announcements\/coronavirus\u2010covid\u201019\u2010update\u2010fda\u2010authorizes\u2010additional\u2010oral\u2010antiviral\u2010treatment\u2010covid\u201019\u2010certain.2021."},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1056\/EVIDe2100048"},{"key":"e_1_2_11_26_1","unstructured":"EMA.https:\/\/www.ema.europa.eu\/en\/documents\/smop\u2010initial\/questions\u2010answers\u2010refusal\u2010marketing\u2010authorisation\u2010lagevrio\u2010molnupiravir_en.pdf.2023."},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.antiviral.2018.04.004"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00766-18"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41564-020-00835-2"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1128\/JVI.01348-19"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.abl7430"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2116044"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s15010\u2010022\u201001959\u20109"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)02597-1"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1056\/EVIDoa2100044"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41401-022-00895-6"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.47102\/annals-acadmedsg.2022289"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/bs.podrm.2022.11.003"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00162-20"},{"key":"e_1_2_11_40_1","unstructured":"EMA.https:\/\/www.ema.europa.eu\/en\/medicines\/human\/EPAR\/veklury.2022."},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-020-20542-0"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2116846"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41422-021-00570-1"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2208822"}],"container-title":["European Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ene.16017","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,27]],"date-time":"2024-02-27T12:06:00Z","timestamp":1709035560000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ene.16017"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,13]]},"references-count":43,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1111\/ene.16017"],"URL":"https:\/\/doi.org\/10.1111\/ene.16017","archive":["Portico"],"relation":{},"ISSN":["1351-5101","1468-1331"],"issn-type":[{"value":"1351-5101","type":"print"},{"value":"1468-1331","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,13]]},"assertion":[{"value":"2023-06-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-28","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-13","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}