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All Studies   All Outcomes    Recent:   
0 0.5 1 1.5 2+ Mortality -110% Improvement Relative Risk Hospitalization, COVID-19 58% Hospitalization, all cause 53% Molnupiravir  Goodwin et al.  EARLY TREATMENT Is early treatment with molnupiravir beneficial for COVID-19? Retrospective 416 patients in the United Kingdom (Dec 2021 - Feb 2022) Study underpowered to detect differences Goodwin et al., PLOS ONE, March 2023 Favors molnupiravir Favors control

Evaluation of outpatient treatment for non-hospitalised patients with COVID-19: The experience of a regional centre in the UK

Goodwin et al., PLOS ONE, doi:10.1371/journal.pone.0281915
Mar 2023  
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Retrospective 604 outpatients in the UK, showing lower risk of hospitalization with molnupiravir treatment, without statistical significance due to the small number of hospitalizations.
Concerns have been raised that the mutagenic mechanism of action may create dangerous variants or cause cancer Chamod, Hadj Hassine, Huntsman, Marikawa, Swanstrom, Waters, Zhou, Zibat. Multiple analyses have identified variants potentially created by molnupiravir Fountain-Jones, Kosakovsky Pond, Sanderson,
Study covers molnupiravir and sotrovimab.
risk of death, 110.0% higher, RR 2.10, p = 0.47, treatment 1 of 80 (1.2%), control 2 of 336 (0.6%).
risk of hospitalization, 58.0% lower, RR 0.42, p = 0.70, treatment 1 of 80 (1.2%), control 10 of 336 (3.0%), NNT 58, COVID-19 related.
risk of hospitalization, 53.3% lower, RR 0.47, p = 0.39, treatment 2 of 80 (2.5%), control 18 of 336 (5.4%), NNT 35, all cause.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Goodwin et al., 15 Mar 2023, retrospective, United Kingdom, peer-reviewed, 3 authors, study period 22 December, 2021 - 20 February, 2022. Contact:
This PaperMolnupiravirAll
Evaluation of outpatient treatment for non-hospitalised patients with COVID-19: The experience of a regional centre in the UK
Amanda T Goodwin, Jonathan S Thompson, Ian P Hall
PLOS ONE, doi:10.1371/journal.pone.0281915
Introduction Antivirals, such as molnupiravir, and SARS-CoV-2 neutralising monoclonal antibodies (nMAbs), such as sotrovimab, reduced the risk of hospitalisation and death in clinical trials of high-risk non-hospitalised patients with Covid-19. However, the real-world benefits of these drugs are unclear. Aims To evaluate the characteristics and outcomes of high-risk patients referred for outpatient antiviral or nMAb treatment for symptomatic Covid-19. Methods The records of patients referred to a large UK Covid Medicines Delivery Unit (CMDU) over nine weeks (December 2021-February 2022) were reviewed. Data were collected on demographics, referral indications, vaccination, deprivation, treatment, complications, hospital admission, and mortality. Results 1820 patients were referred to the CMDU, with 604 (33.2%) suitable for further assessment. 169 patients received sotrovimab, 80 patients received molnupiravir, 70 patients declined treatment, and 266 were ineligible for treatment because of resolving symptoms. There were trends towards higher proportions of female and white patients, lower deprivation scores, and malignancy-or transplant-related indications in the groups receiving treatment compared with untreated patients. Covid-19-related hospitalisations occurred in 1.2% of the treated group and 3.0% of the untreated group indicating a potential treatment effect, however Covid-related hospitalisations were lower than reported in the original clinical trials (2.2% compared with 7-10%). Conclusion The referral pathways for outpatient treatment of Covid-19 are inefficient, and the UK system may not be serving all groups equitably. Hospitalisation with Covid-19 was rare
Bernal, Da Silva, Musungaie, Molnupiravir for oral treatment of Covid-19 in nonhospitalized patients, N Eng J Med, doi:10.1056/NEJMoa2116044
Bruel, Hadjadj, Maes, Serum neutralization of SARS-CoV-2 Omicron sublineages BA.1 and BA.2 in patients receiving monoclonal antibodies, Nat Med, doi:10.1038/s41591-022-01792-5
Chavarot, Melenotte, Amrouche, Early treatment with sotrovimab monoclonal antibody in kidney transplant recipients with Omicron infection, Kidney Int, doi:10.1016/j.kint.2022.04.003
Deng, Heybati, Ba, Differential efficacy and safety of anti-SARS-CoV-2 antibody therapies for the management of COVID-19: a systematic review and network meta-analysis, Infection, doi:10.1007/s15010-022-01825-8
Dhand, Okumura, Wolfe, Sotrovimab for treatment of COVID-19 in solid organ transplant recipients, Transplantation, doi:10.1097/TP.0000000000004136
Gupta, Gonzales-Rojas, Juarez, Early treatment for Covid-19 with SARS-CoV-2 Neutralizing antibody sotrovimab, N Engl J Med, doi:10.1056/NEJMoa2107934
Gupta, Gonzales-Rojas, Juarez, Effect of sotrovimab on hospitalisation or death among high-risk patients with mild to moderate COVID-19: a randomized clinical trial, JAMA, doi:10.1001/jama.2022.2832
Nhs England, Statistical work areas: COVID-19 therapeutics (antivirals, neutralising monoclonal antibodies, and interleukin 6 inhibitors
Scobie, Morris, Quality and inequality: digging deeper
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