Nirmatrelvir: from discovery to modern and alternative synthetic approaches

The global urgency in response to the COVID-19 pandemic has catalyzed extensive research into discovering efficacious antiviral compounds against SARS-CoV-2. Among these, Nirmatrelvir (PF-07321332) has emerged as a promising candidate, exhibiting potent antiviral activity by targeting the main protease of SARS-CoV-2, and has been marketed in combination with ritonavir as the first oral treatment for COVID-19 with the name of PaxlovidTM. This review outlines the synthetic approaches to Nirmatrelvir, ranging from Pfizer’s original method to newer, more sustainable strategies, such as flow chemistry strategies and multicomponent reactions. Each approach’s novelty and contributions to yield and purification processes are highlighted. Additionally, the synthesis of key fragments comprising Nirmatrelvir and innovative optimization strategies are discussed.