The first-ever COVID-19 pill may be just weeks away. A handful of other pills, inhalers, and nasal sprays also show promise.

• Treating COVID-19 could be simpler soon, thanks to the next generation of treatments.
• These could come in the form of pills, nasal sprays, or inhalers.
• On Monday, Merck asked the FDA to authorize its antiviral pill, which would be the first COVID-19 treatment of its kind.

COVID-19 could get a lot easier to treat in the near future.

Thus far, doctors have relied on expensive, invasive drugs that are limited in supply and often complicated to administer. But biotech and pharma companies are now working on simpler treatments that people could take as pills, nasal sprays, or inhalers.

An antiviral drug from Merck and Ridgeback Biotherapeutics is on track to become the first pill authorized to treat COVID-19. On Monday, the companies asked the Food and Drug Administration (FDA) to authorize that treatment, which was found to reduce the risk of hospitalization or death among adults with mild to moderate COVID-19. If the FDA thinks the data is sound enough, it could greenlight the pill within weeks.

So far, the FDA has fully approved just one treatment for COVID-19: the antiviral drug remdesivir, which is administered via injection. The drug has been shown to shorten the recovery time of hospitalized patients.

The FDA also authorized the emergency use of monoclonal antibodies, drugs that help keep people with mild or moderate symptoms from developing severe COVID-19. These come in two forms: infusions or injections.

Pills or sprays, however, could make it easier for people to treat COVID-19 symptoms right away, perhaps without needing to visit hospitals. Pills are also likely to be cheaper than antibody infusions, which are free for patients but cost the US government more than $1,000 per dose.

The following drugs have shown the most promise in trials as potential COVID-19 treatments. None of them is a replacement for vaccines, though.

Antiviral pills could lower the risk of hospitalization

Warding off severe COVID-19 could eventually be as simple as taking a few pills.

Merck's antiviral, molnupiravir, was originally developed as a treatment for the flu. Now it's being evaluated for mild to moderate COVID-19 in a study of nearly 1,900 volunteers. So far, the pill has halved the risk of hospitalization or death among a group of 385 people, Merck announced earlier this month. The participants took 40 pills in total: four capsules twice a day for five days.

The pill belongs to a class of antiviral drugs called nucleosides, which try to block the virus from replicating inside cells.

Two other companies, Roche and Atea Pharmaceuticals, are also jointly developing a nucleoside pill. That drug, called AT-527, was shown to reduce the amount of virus present in hospitalized patients with moderate COVID-19. The study was small, though - around 60 people - so Roche is waiting on data from a study of nearly 1,400 people, which could be available before the end of the year.

Not all prospective COVID-19 pills are the same

Other companies are developing antiviral pills called protease inhibitors, which target an enzyme involved in the viral replication process.

Pfizer is testing such a drug in combination with a low dose of another antiviral that slows the breakdown of the drug so it lasts longer in the body. The company kicked off a 3,000-person study in July and hopes to get data before the end of 2021.

Meanwhile, a protease inhibitor from Japanese drugmaker Shionogi could help people with mild or asymptomatic infections. The company began a late-stage study in September.

Two smaller biotech companies - Pardes Biosciences and Enanta Pharmaceuticals - are working on their own protease inhibitors, but they're far from late-stage studies. Pardes launched a 110-person trial in August, and those results could be ready by the end of the year. Enanta hopes to start initial testing of its pill in people in early 2022. The company previously developed a treatment for hepatitis C.

Nasal sprays may be useful immediately after exposure to the virus

The coronavirus first invades the body through the nose, eyes, and throat, so scientists think there's an advantage to administering treatments directly into those areas.

Nasal sprays, for instance, could kill or weaken the virus in the upper airways, before it spreads to the lungs, where it's likely to cause the most damage.

A May study found that a nasal spray from the biotech company SaNOtize reduced the amount of virus present among 40 people with mild COVID-19. The spray uses a colorless gas called nitric oxide that's found naturally in the body. Israel is now offering that drug in pharmacies.

Another company, IGM Biosciences, is developing a nasal spray that contains an antibody engineered to neutralize the coronavirus. The spray reduced the amount of virus in the lungs of mice, but scientists don't yet know whether it will be effective in humans. Zhiqiang An, a professor of molecular medicine who's involved in the research, told Nature that the spray could eventually serve as an emergency treatment after someone has been exposed to the coronavirus.

Inhalers could shorten recovery among hospitalized patients

A couple of inhaled COVID-19 medicines are also showing promise, though more research is needed.

In a study of about 100 hospitalized COVID-19 patients, an inhaler from Synairgen was found boost the odds of improvement and lead to quicker recovery times relative to patients who received a placebo.

The inhaler uses a naturally occurring protein to stimulate the immune response in the lungs. Synairgen expects results from a late-stage study in hospitalized patients in early 2022.

A large study also found benefits from inhaled budesonide, a generic anti-inflammatory drug that treats asthma and chronic obstructive pulmonary disease. A UK study in high-risk COVID-19 patients found that budesonide helped people recover about three days faster than those who received standard care. But the same study found that budesonide didn't significantly reduce hospitalizations or deaths.

This story has been updated with new information. It was originally published October 6.