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All Studies   All Outcomes    Recent:   

Randomized Trial of Molnupiravir or Placebo in Patients Hospitalized with Covid-19

Arribas et al., NEJM Evidence, doi:10.1056/EVIDoa2100044, MOVe-IN, NCT04575584
Dec 2021  
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0 0.5 1 1.5 2+ Mortality -282% Improvement Relative Risk Mortality (b) -217% Mortality (c) -317% Mortality (d) -311% Recovery 1% Recovery (b) 12% Recovery (c) -1% Recovery time 0% no CI Recovery time (b) 0% no CI Recovery time (c) 0% no CI Viral clearance 12% Viral clearance (b) -2% Viral clearance (c) 21% Viral clearance (d) 8% Viral clearance (e) -48% Viral clearance (f) 21% Molnupiravir  MOVe-IN  LATE TREATMENT  DB RCT Is late treatment with molnupiravir beneficial for COVID-19? Double-blind RCT 291 patients in multiple countries (Oct 2020 - Jan 2021) Higher mortality (p=0.31) and improved viral clearance (p=0.57), not sig. Arribas et al., NEJM Evidence, December 2021 Favors molnupiravir Favors control
RCT 304 hospitalized patients, 218 treated with molnupiravir, showing no significant differences. MOVe-IN MK-4482-001. NCT04575584 (history).
Concerns have been raised that the mutagenic mechanism of action may create dangerous variants or cause cancer1-9. Multiple analyses have identified variants potentially created by molnupiravir10-13.
risk of death, 281.9% higher, RR 3.82, p = 0.31, treatment 11 of 216 (5.1%), control 1 of 75 (1.3%), combined, excluding imputed deaths.
risk of death, 216.9% higher, RR 3.17, p = 0.36, treatment 3 of 71 (4.2%), control 1 of 75 (1.3%), 800mg, excluding imputed death.
risk of death, 316.7% higher, RR 4.17, p = 0.20, treatment 4 of 72 (5.6%), control 1 of 75 (1.3%), 400mg, excluding imputed death.
risk of death, 311.0% higher, RR 4.11, p = 0.21, treatment 4 of 73 (5.5%), control 1 of 75 (1.3%), 200mg.
risk of no recovery, 1.0% lower, RR 0.99, p = 0.96, treatment 72, control 75, inverted to make RR<1 favor treatment, 800mg.
risk of no recovery, 11.5% lower, RR 0.88, p = 0.53, treatment 73, control 75, inverted to make RR<1 favor treatment, 400mg.
risk of no recovery, 1.0% higher, RR 1.01, p = 0.96, treatment 73, control 75, inverted to make RR<1 favor treatment, 200mg.
recovery time, no change, relative time 1.00, treatment 72, control 75, 800mg.
recovery time, no change, relative time 1.00, treatment 73, control 75, 400mg.
recovery time, no change, relative time 1.00, treatment 73, control 75, 200mg.
risk of no viral clearance, 11.8% lower, RR 0.88, p = 0.57, treatment 26 of 52 (50.0%), control 34 of 60 (56.7%), NNT 15, 800mg, Table S16, day 15 mid-recovery.
risk of no viral clearance, 2.4% higher, RR 1.02, p = 1.00, treatment 29 of 50 (58.0%), control 34 of 60 (56.7%), 400mg, Table S16, day 15 mid-recovery.
risk of no viral clearance, 20.6% lower, RR 0.79, p = 0.27, treatment 27 of 60 (45.0%), control 34 of 60 (56.7%), NNT 8.6, 200mg, Table S16, day 15 mid-recovery.
risk of no viral clearance, 8.3% lower, RR 0.92, p = 1.00, treatment 9 of 53 (17.0%), control 10 of 54 (18.5%), NNT 65, 800mg, Table S16, day 29.
risk of no viral clearance, 48.2% higher, RR 1.48, p = 0.35, treatment 14 of 51 (27.5%), control 10 of 54 (18.5%), 400mg, Table S16, day 29.
risk of no viral clearance, 21.5% lower, RR 0.79, p = 0.61, treatment 8 of 55 (14.5%), control 10 of 54 (18.5%), NNT 25, 200mg, Table S16, day 29.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Arribas et al., 16 Dec 2021, Double Blind Randomized Controlled Trial, multiple countries, peer-reviewed, 21 authors, study period 19 October, 2020 - 12 January, 2021, average treatment delay 7.1 days, trial NCT04575584 (history) (MOVe-IN).
This PaperMolnupiravirAll
Randomized Trial of Molnupiravir or Placebo in Patients Hospitalized with Covid-19
José R Arribas, M.D Sanjay Bhagani, M.D Suzana M Lobo, M.D Ilsiyar Khaertynova, M.D Lourdes Mateu, M.D Roman Fishchuk, M.D William Y Park, M.D Khetam Hussein, M.D Sei Won Kim, M.D Jade Ghosn, Michelle L Brown, Ph.D Ying Zhang, Ph.D Wei Gao, Ph.D Christopher Assaid, Ph.D Jay A Grobler, Ph.D Julie Strizki, Mary Vesnesky, M.D Amanda Paschke, M.D Joan R Butterton, Pharm.D Carisa De Anda
NEJM Evidence, doi:10.1056/evidoa2100044
BACKGROUND Molnupiravir is an oral prodrug of b-D-N4-hydroxycytidine, active against SARS-CoV-2 in vitro and in animal models. We report data from the phase 2 component of MOVe-IN, a clinical trial evaluating molnupiravir in patients hospitalized with Covid-19. METHODS We conducted a randomized, placebo-controlled, double-blind phase 2/3 trial in patients 18 years old and older requiring in-hospital treatment for laboratoryconfirmed Covid-19 with symptom onset 10 or fewer days before randomization. Participants were randomly assigned to placebo or molnupiravir 200 mg, 400 mg, or 800 mg (1:1:1:1 ratio), twice daily for 5 days. Primary end points were safety and sustained recovery (participant alive and either not hospitalized or medically ready for discharge) through day 29. RESULTS Of 304 randomly assigned participants, 218 received at least one dose of molnupiravir and 75 of placebo. At baseline, 74.0% had at least one risk factor for severe Covid-19. Adverse events were reported in 121 of 218 (55.5%) molnupiravir-treated and 46 of 75 (61.3%) placebo-treated participants, with no apparent dose effect on adverse event rates and no evidence of hematologic toxicity based on prespecified adverse events. Of 16 confirmed deaths, most were in participants with severe Covid-19 (75.0%), with underlying comorbidities (87.5%), older than 60 years of age (81.3%), and/or symptom duration longer than 5 days (75.0%) at randomization. Median time to sustained recovery was 9 days in all groups, with similar day 29 recovery rates ranging from 81.5% to 85.2%.
Author Affiliations 1 Infectious Diseases Unit, Hospital Universitario La Paz-IdiPAZ, Madrid 2 Department of Infectious Diseases, Royal Free Hospital, London
Abdelnabi, Foo, Jonghe, Maes, Weynand et al., Molnupiravir inhibits the replication of the emerging SARS-CoV-2 variants of concern (VoCs) in a hamster infection model, J Infect Dis, doi:10.1093/infdis/jiab361
Beigel, Tomashek, Dodd, ACTT-1 Study Group Members. Remdesivir for the treatment of Covid-19 -final report, N Engl J Med, doi:10.1056/NEJMoa2007764
Bernal, Da Silva, Musungaie, Molnupiravir for oral treatment of Covid-19 in nonhospitalized patients, N Engl J Med, doi:10.1056/NEJMoa2116044
Caraco, Crofoot, Moncada, Phase 2/3 trial of molnupiravir for treatment of Covid-19 in non-hospitalized adults, NEJM Evid, doi:10.1056/EVIDoa2100043
Cevik, Tate, Lloyd, Maraolo, Schafers et al., SARS-CoV-2, SARS-CoV, and MERS-CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review and meta-analysis, Lancet Microbe, doi:10.1016/S2666-5247(20)30172-5
Chawla, Cao, Stone, Model-based dose selection for the phase 3 evaluation of molnupiravir (MOV) in the treatment of COVID-19 in adults, ESCMID eAcademy
Cox, Wolf, Plemper, Therapeutically administered ribonucleoside analogue MK-4482/EIDD-2801 blocks SARS-CoV-2 transmission in ferrets, Nat Microbiol, doi:10.1038/s41564-020-00835-2
Docherty, Harrison, Green, ISARIC4C investigators. Features of 20 133 UK patients in hospital with covid-19 using the ISA-RIC WHO Clinical Characterisation Protocol: prospective observational cohort study, BMJ, doi:10.1136/bmj.m1985
Fischer, Eron, Holman, Molnupiravir, an oral antiviral treatment for COVID-19, medRxiv, doi:10.1101/2021.06.17.21258639v1
Gottlieb, Nirula, Chen, Effect of bamlanivimab as monotherapy or in combination with etesevimab on viral load in patients with mild to moderate COVID-19: a randomized clinical trial, JAMA, doi:10.1001/jama.2021.0202
Heflich, Dertinger, Dobrovolsky, The in vivo erythrocyte Pig-a gene mutation assay -Part 1 -detailed review paper and retrospective performance assessment
Horby, Lim, Emberson, RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with COVID-19, N Engl J Med, doi:10.1056/NEJMoa2021436
Jones, Biele, M€ Uhlemann B, Estimating infectiousness throughout SARS-CoV-2 infection course, Science, doi:10.1126/science.abi5273
Kalil, Patterson, Mehta, ACTT-2 Study Group Members. Baricitinib plus remdesivir for hospitalized adults with Covid-19, N Engl J Med, doi:10.1056/NEJMoa2031994
Klopfenstein, Gendrin, Gerazime, HNF Hospital tocilizumab multidisciplinary team. Systematic review and subgroup meta-analysis of randomized trials to determine tocilizumab's place in COVID-19 pneumonia, Infect Dis Ther, doi:10.1007/s40121-021-00488-6
Kyriazopoulou, Poulakou, Milionis, Early treatment of COVID-19 with anakinra guided by soluble urokinase plasminogen receptor plasma levels: a double-blind, randomized controlled phase 3 trial, Nat Med, doi:10.1038/s41591-021-01499-z
Libster, Erez Marc, Wappner, Fundaci on INFANT-COVID-19 Group. Early high-titer plasma therapy to prevent severe COVID-19 in older adults, N Engl J Med, doi:10.1056/NEJMoa2033700
Ly-Cov555, Group; Lundgren, Grund, Barkauskas, A neutralizing monoclonal antibody for hospitalized patients with COVID-19, N Engl J Med, doi:10.1056/NEJMoa2033130
Macedo, Gonc ¸alves, Febra, COVID-19 fatality rates in hospitalized patients: systematic review and meta-analysis, Ann Epidemiol, doi:10.1016/j.annepidem.2021.02.012
Marconi, Ramanan, De Bono, Efficacy and safety of baricitinib in patients with COVID-19 infection: results from the randomised, double-blind, placebo-controlled, parallel-group COV-BARRIER phase 3 trial, Lancet Respir Med, doi:10.1101/2021.04.30.21255934v2
Painter, Holman, Bush, Human safety, tolerability, and pharmacokinetics of molnupiravir, a novel broad-spectrum oral antiviral agent with activity against SARS-CoV-2, Antimicrob Agents Chemother, doi:10.1128/AAC.02428-20
Pan, Peto, Henao-Restrepo, WHO Solidarity Trial Consortium. Repurposed antiviral drugs for Covid-19 -interim WHO solidarity trial results, N Engl J Med, doi:10.1056/NEJMoa2023184
Patel, Beishuizen, Ruiz, A randomized trial of otilimab in severe COVID-19 pneumonia (OSCAR), medRxiv, doi:10.1101/2021.04.14.21255475v1
Salama, Han, Yau, Tocilizumab in patients hospitalized with Covid-19 pneumonia, N Engl J Med, doi:10.1056/NEJMoa2030340
Sheahan, Sims, Zhou, An orally bioavailable broadspectrum antiviral inhibits SARS-CoV-2 in human airway epithelial cell cultures and multiple coronaviruses in mice, Sci Transl Med, doi:10.1126/scitranslmed.abb5883
Tenforde, Rose, Lindsell, CDC COVID-19 Response Team. Characteristics of adult outpatients and inpatients with COVID-19 -11 academic medical centers, United States, MMWR Morb Mortal Wkly Rep, doi:10.15585/mmwr.mm6926e3
Troth, Butterton, Deanda, Letter to the editor in response to Zhou et al, J Infect Dis, doi:10.1093/infdis/jiab362
Urakova, Kuznetsova, Crossman, b-d-N 4 -Hydroxycytidine is a potent anti-alphavirus compound that induces a high level of mutations in the viral genome, J Virol, doi:10.1128/JVI.01965-17
Wahl, Gralinski, Johnson, SARS-CoV-2 infection is effectively treated and prevented by EIDD-2801, Nature, doi:10.1038/s41586-021-03312-w
Weinreich, Sivapalasingam, Norton, Trial Investigators. REGN-COV2, a neutralizing antibody cocktail, in outpatients with Covid-19, N Engl J Med, doi:10.1056/NEJMoa2035002
Yoon, Toots, Lee, Orally efficacious broad-spectrum ribonucleoside analog inhibitor of influenza and respiratory syncytial viruses, Antimicrob Agents Chemother, doi:10.1128/AAC.00766-18
Zhou, Hill, Sarkar, b-d-N4-hydroxycytidine inhibits SARS-CoV-2 through lethal mutagenesis but is also mutagenic to mammalian cells, J Infect Dis, doi:10.1093/infdis/jiab247
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Late treatment
is less effective
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