The outbreak and rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have led to one of the most serious public health crises since the beginning of the 21st century. An oral anti-SARS-CoV-2 drug ensitrelvir was developed with satisfactory antiviral effect and was synthesized via different strategies. This Review summarizes the advantages and disadvantages of the currently reported synthetic strategies for ensitrelvir along with three related key building blocks derivatives from the view of procedure, yield, impurities, safety, and environment. This will provide a novel perspective for further process development and drug discovery.