Molnupiravir for treatment of adults with mild or moderate COVID-19: a systematic review and meta-analysis of randomised controlled trials

Link to article at PubMed

Clin Microbiol Infect. 2023 Apr 19:S1198-743X(23)00185-4. doi: 10.1016/j.cmi.2023.04.014. Online ahead of print.


BACKGROUND: The effects of molnupiravir in treating patients with non-severe COVID-19 remain uncertain.

OBJECTIVES: To evaluate the efficacy and safety of molnupiravir in adult patients with mild or moderate COVID-19.

DATA SOURCES: PubMed, Embase, CENTRAL, Web of Science, and WHO COVID-19 database up to December 27, 2022.

STUDY ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) with no language restrictions.

PARTICIPANTS: Adults with mild or moderate COVID-19.

INTERVENTIONS: Molnupiravir against standard care or placebo.

ASSESSMENT OF RISK OF BIAS: We used a revision of RoB-2 criteria.

METHODS OF DATA SYNTHESIS: Outcomes were mortality, hospital admission, viral clearance, time to viral clearance, time to symptom resolution or clinical improvement, any adverse events, and serious adverse events. We performed DerSimonian-Laird random effects meta-analyses to summarize the evidence and evaluated the certainty of evidence using the GRADE approach.

RESULTS: Nine RCTs enrolling 30,472 patients proved eligible. Majority of patients were outpatients, with the mean age ranging from 35 to 56.6 years. In adult patients with mild or moderate COVID-19, molnupiravir probably reduces mortality (relative risk (RR) 0.43, 95% CI 0.20 to 0.94, risk difference (RD) 0.1% fewer; moderate certainty) and the risk of hospital admission (RR 0.67, 95% CI 0.45 to 0.99, RD 1.4% fewer; moderate certainty), and may reduce time to viral clearance (MD -1.81 days, 95% CI -3.31 to -0.31; low certainty) and time to symptom resolution or clinical improvement (MD -2.39 days, 95% CI -3.71 to -1.07; low certainty). Molnupiravir probably increases rate of viral clearance (RR 3.47, 95% CI 2.43 to 4.96, RD 16.1% more; moderate certainty) at 7 days (±3 days) and likely does not increase serious adverse events (RR 0.84, 95% CI 0.61 to 1.15, RD 0.1% fewer; moderate certainty).

CONCLUSIONS: In adult patients with mild or moderate COVID-19, molnupiravir likely reduces mortality and risk of hospital admission probably without increasing serious adverse events.

PMID:37084941 | DOI:10.1016/j.cmi.2023.04.014

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