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Comparison of effectiveness and safety of molnupiravir versus sotrovimab for COVID‐19: A systematic review and meta‐analysis

Amani et al., Immunity, Inflammation and Disease, doi:10.1002/iid3.1262, PROSPERO CRD42023429910
Apr 2024  
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Meta analysis of 13 studies involving 16,166 patients showing higher mortality and higher incidence of adverse events with molnupiravir compared with sotrovimab.
Concerns have been raised that the mutagenic mechanism of action may create dangerous variants or cause cancer Chamod, Gruber, Hadj Hassine, Huntsman, Marikawa, Swanstrom, Waters, Zhou, Zibat. Multiple analyses have identified variants potentially created by molnupiravir Fountain-Jones, Kosakovsky Pond, Sanderson, twitter.com.
Currently there are 40 molnupiravir studies and meta analysis shows:
OutcomeImprovement
Mortality22% lower [9‑33%]
Ventilation29% lower [-15‑56%]
ICU admission7% lower [-14‑24%]
Hospitalization2% lower [-8‑10%]
Cases24% fewer [-1‑43%]
Study covers sotrovimab and molnupiravir.
Amani et al., 23 Apr 2024, peer-reviewed, 2 authors, trial PROSPERO CRD42023429910. Contact: b_amani@alumnus.tums.ac.ir.
This PaperMolnupiravirAll
Comparison of effectiveness and safety of molnupiravir versus sotrovimab for COVID‐19: A systematic review and meta‐analysis
Bahman Amani, Behnam Amani
Immunity, Inflammation and Disease, doi:10.1002/iid3.1262
Background and Aim: This systematic review and meta-analysis aimed to compare the effectiveness and safety of molnupiravir and sotrovimab in the treatment of patients with coronavirus disease 2019 (COVID-19). Methods: Cochrane Library, Web of Science, PubMed, medRxiv, and Google Scholar were systematically searched to identify relevant evidence up to December 2023. The risk of bias was assessed using the risk of bias in nonrandomized studies of interventions tool. Data were analyzed using Comprehensive Meta-Analysis (CMA). Results: Our search identified and included 13 studies involving 16166 patients. The meta-analysis revealed a significant difference between the molnupiravir and sotrovimab groups in terms of the mortality rate (odds ratio [OR] = 2.07, 95% confidence interval [CI]: 1.16, 3.70). However, no significant difference was observed between the two groups in terms of hospitalization rate (OR = 0.71, 95% CI: 0.47, 1.06), death or hospitalization rate (OR = 1.51, 95% CI: 0.81, 2.83), and intensive care unit admission (OR = 0.59, 95% CI: 0.07, 4.84). In terms of safety, molnupiravir was associated with a higher incidence of adverse events (OR = 1.67, 95% CI: 1.21, 2.30). Conclusion: The current findings indicate that sotrovimab may be more effective than molnupiravir in reducing the mortality rate in COVID-19 patients. However, no statistical difference was observed between the two treatments for other effectiveness outcomes. The certainty of evidence for these findings was rated as low or moderate. Further research is required to provide a better comparison of these interventions in treating COVID-19 patients.
AUTHOR CONTRIBUTIONS Conceptualization and project administration: Bahman Amani and Behnam Amani. Literature searching: Behnam Amani and Bahman Amani. Data extraction and quality assessment: Bahman Amani and Behnam Amani. Data analysis: Bahman Amani and Behnam Amani. Writing-original draft: Behnam Amani. Writing-review and editing: Bahman Amani and Behnam Amani. CONFLICT OF INTEREST STATEMENT The authors declare no conflict of interest. SUPPORTING INFORMATION Additional supporting information can be found online in the Supporting Information section at the end of this article.
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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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