1. All-cause hospitalizations and deaths were reported in 1% of patients in the molnupiravir and usual care groups, with no significant differences.
2. The molnupiravir group reported a quicker time to recovery and quicker time to symptom severity reduction compared to usual care only.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Molnupiravir is an antiviral medication that was initially developed for influenza. Whether this antiviral agent may have beneficial effects for the treatment of other respiratory viruses is unclear. However, molnupiravir may play a role in the early treatment of COVID-19 by binding to viral RNA and inhibiting replication. This randomized controlled trial aimed to compare the effect of molnupiravir on hospitalizations and deaths among adults with COVID-19. Patients were randomly assigned to either the intervention (molnupiravir 800 mg twice daily for 5 days) or the usual care group and followed for 28 days. The primary outcome was all-cause hospital admission or death within 4 weeks. According to study results, molnupiravir had minimal to no effect on hospitalizations and death among COVID-19 patients compared to usual care alone. However, molnupiravir appeared to reduce the duration of symptoms and decrease time to symptom improvement. This study was strengthened by a large sample size that included patients of all ages, thus increasing its validity.
Click to read the study in The Lancet
Relevant Reading: Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients
In-depth [randomized-controlled trial]: Between Dec 8, 2021, and Apr 27, 2022, 112 748 patients were assessed for eligibility from multiple sites across the UK. Eligible individuals were patients in the community ≥ 50 years or ≥ 18 years with relevant comorbidities who were symptomatic for COVID-19 with a positive PCR or rapid antigen SARS-CoV-2 test within the past 7 days. Altogether, 25 054 patients (12 529 in the molnupiravir plus usual care group and 12 525 in the usual care group) were included in the primary analysis. The primary outcome of all-cause hospitalizations or death was comparable in both groups (1% in molnupiravir plus usual care vs. 1% in usual care alone, adjusted odds ratio [aOR] 1.06, 95% Bayesian credible interval 0.81-1.41, probability of superiority 0.33). This was also the case for serious adverse events (0.4% in molnupiravir plus usual care vs. 0.3% in usual care alone). On average, the time to first reported recovery was 9 days in the molnupiravir group compared to 15 days in the usual care group. Overall, findings from this study suggest that molnupiravir is not superior to usual care for COVID-19-related hospitalizations or death.
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