Real-World Clinical Outcomes of Molnupiravir for the Treatment of Mild to Moderate COVID-19 in Adult Patients during the Dominance of the Omicron Variant: A Meta-Analysis

Abstract

Introduction: The therapeutic impact of molnupiravir in the Omicron variant phase is unknown. The goal of the current meta-analysis was to compare the real-world clinical outcomes of molnupiravir for the treatment of mild to moderate COVID-19 during the dominance of the Omicron variant in adult patients to that of a placebo. Methods: To be included, studies had to directly compare the clinical effectiveness of molnupiravir in treating adult COVID-19 patients to that of a placebo. Studies were included based on the following outcomes: all-cause mortality, composite outcome of disease progression, hospitalization rate, and viral load. Results: The current meta-analysis included six studies that indicated that the risk of mortality was reduced by 34%, and the risk of composite outcome of disease progression was reduced by 37% among patients who received molnupiravir. Molnupiravir was associated with faster reduction in viral loads than the placebo. There was no clinical benefit of reducing all-cause mortality in mild to moderate COVID-19 patients with high COVID-19 vaccination coverage. Conclusion: The clinical effectiveness of molnupiravir was associated with COVID-19 vaccination coverage in COVID-19 patients. There is a lack of detailed data on its effectiveness in vaccinated patients, especially those with low COVID-19 vaccination coverage.

Comparative efficacy and safety of nirmatrelvir/ritonavir and molnupiravir for COVID‐19: A systematic review and meta‐analysis

“…According to this meta‐analysis, the all‐cause hospitalization rate was statistically lower in the nirmatrelvir/ritonavir‐treated patients compared to those receiving molnupiravir. Meta‐analyses 6,7 revealed that both treatments can reduce the admission to the hospital due to COVID‐19 disease. However, real‐world studies 14,28 on nonhospitalized COVID‐19 patients showed that nirmatrelvir/ritonavir‐treated patients are less likely to be hospitalized compared to the molnupiravir‐receiving ones.…”

“…Recently published meta‐analyses 6,7 indicated the higher effectiveness of nirmatrelvir/ritonavir and molnupiravir in improving the mortality rate of patients with COVID‐19 compared to the controls. The present meta‐analysis demonstrated that treatment of COVID‐19 with nirmatrelvir/ritonavir is associated with a statistically lower rate of mortality compared to those treated with molnupiravir.…”

“…4,5 Several therapeutic interventions have been developed and proposed to reduce severe COVID-19 and mortality in patients infected with SARS-CoV-2. [6][7][8] Anti-SARS-CoV-2 monoclonal antibodies (mAb) [8][9][10] and antiviral agents 11 have shown to be effective in such conditions. However, there is no persuasive evidence of clinical benefit for any mAb and antiviral treatments.…”

“…This becomes more important in high‐risk patients who are at greater risk of sever COVID‐19 and mortality rate 4,5 . Several therapeutic interventions have been developed and proposed to reduce severe COVID‐19 and mortality in patients infected with SARS‐CoV‐2 6–8 . Anti‐SARS‐CoV‐2 monoclonal antibodies (mAb) 8–10 and antiviral agents 11 have shown to be effective in such conditions.…”

Molnupiravir’s real-world effectiveness in COVID-19 non-hospitalized patients at high risk of severe disease: a single-center study

“…In a study conducted among U.S. veterans aged 65 years and older, receipt of molnupiravir was associated with a lower 30-day risk of hospitalization or death (RR 0.67, 95% CI 0.46 to 0.99), but the overall result between treated and untreated patients was similar [16]. The meta-analysis by Huang et al, which included six studies involving 89,480 patients (22,355 of whom received molnupiravir therapy and 67,125 of whom received placebo therapy), indicated that the risk of mortality was reduced by 34% and the risk of the composite outcome of disease progression was reduced by 37% among patients who received molnupiravir [17].…”