Disease Progression of Hospitalized Elderly Patients with Omicron BA.2 Treated with Molnupiravir

Liu et al., Infectious Diseases and Therapy, doi:10.1007/s40121-022-00716-7, Oct 2022
Early treatmentRetrospective ยท 42 patients ยท China ยท Mar โ€“ May 2022
Molnupiravir for COVID-19
Retrospective 42 elderly patients in China showing faster viral clearance with molnupiravir.
Potential risks of molnupiravir include the creation of dangerous variants, and mutagenicity, carcinogenicity, teratogenicity, and embryotoxicity1-15. Multiple analyses have identified variants potentially created by molnupiravir16-20. Studies show significantly increased risk of acute kidney injury21, cardiovascular toxocity22, and neurological symptoms21. Treatment may increase viral rebound23,24.
Standard of Care (SOC) for COVID-19 in the study country, China, is average with moderate efficacy for approved treatments25.
OutcomeImprovementEffect ยท pTreatmentControl
risk of ICU admission 161.5% higher ยท RR 2.62 ยท p = 1.00 161.5% higherRR 2.62p = 1.00 1 of 26 (3.8%) 0 of 16 (0.0%) treatment 1 of 26 (3.8%), control 0 of 16 (0.0%)continuity correction due to zero events
risk of progression 7.7% lower ยท RR 0.92 ยท p = 1.00 7.7% lowerRR 0.92p = 1.00 3 of 26 (11.5%) 2 of 16 (12.5%) treatment 3 of 26 (11.5%), control 2 of 16 (12.5%)dyspnea or ICUNNT 104
hospitalization time 17.9% lower ยท relative time 0.82 ยท p = 0.14 17.9% lowerrelative time 0.82p = 0.14 26 16 treatment 26, control 16
time to viral- 21.4% lower ยท relative time 0.79 ยท p = 0.10 21.4% lowerrelative time 0.79p = 0.10 26 16 treatment 26, control 16
risk of no viral clearance 23.1% higher ยท RR 1.23 ยท p = 1.00 23.1% higherRR 1.23p = 1.00 2 of 26 (7.7%) 1 of 16 (6.2%) treatment 2 of 26 (7.7%), control 1 of 16 (6.2%)day 21
risk of no viral clearance 28.2% lower ยท RR 0.72 ยท p = 0.51 28.2% lowerRR 0.72p = 0.51 7 of 26 (26.9%) 6 of 16 (37.5%) treatment 7 of 26 (26.9%), control 6 of 16 (37.5%)NNT 9.5day 14
risk of no viral clearance 38.5% lower ยท RR 0.62 ยท p = 0.04* 38.5% lowerRR 0.62p = 0.04* 14 of 26 (53.8%) 14 of 16 (87.5%) treatment 14 of 26 (53.8%), control 14 of 16 (87.5%)NNT 3.0day 10
risk of no viral clearance 17.9% lower ยท RR 0.82 ยท p = 0.22 17.9% lowerRR 0.82p = 0.22 20 of 26 (76.9%) 15 of 16 (93.8%) treatment 20 of 26 (76.9%), control 15 of 16 (93.8%)NNT 5.9day 7
risk of no viral clearance 11.5% lower ยท RR 0.88 ยท p = 0.28 11.5% lowerRR 0.88p = 0.28 23 of 26 (88.5%) 16 of 16 (100.0%) treatment 23 of 26 (88.5%), control 16 of 16 (100.0%)NNT 8.7day 5

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates. * p < 0.05

Liu et al., 30 Oct 2022, retrospective, China, peer-reviewed, median age 84.0, 10 authors, study period 26 March, 2022 - 31 May, 2022. Contact: liangxuesong2000@163.com, 452055289@qq.com, redmaples2005@163.com, 18351977696@163.com, zhongwu@bmi.ac.cn, xuaijing86@163.com, fansy@bmi.ac.cn, 1042956281@qq.com, 617943178@qq.com, yxdongxu@126.com.
$0 $500 $1,000+ Efficacy vs. cost for COVID-19 treatment protocols c19early.org November 2026 China Angola Colombia Kenya Mozambique Myanmar South Africa Peru Philippines USA Brazil France Italy Canada Pakistan Spain Vietnam Japan Nepal Iran Bangladesh Ethiopia Ghana Germany Mexico South Korea United Kingdom Saudi Arabia Algeria Morocco Yemen Poland Thailand Uganda Egypt Nigeria Taiwan Fiji Zambia Bosnia-Herzegovina Dominican Republic Bolivia Cรดte d'Ivoire Eritrea Togo Bulgaria Greece Slovakia Iceland New Zealand Trinidad and Tobago Mongolia Czechia Belarus Israel Haiti North Macedonia Hong Kong Qatar Panama Serbia Benin Burundi Cameroon CAR China favored low-cost treatments.The average efficacy of treatments was moderate.Low-cost treatments improve early treatment, andprovide complementary/synergistic benefits. More effective More expensive 75% 50% 25% โ‰ค0%
$0 $500 $1,000+ Efficacy vs. cost for COVID-19treatment protocols worldwide c19early.org November 2026 China Angola Colombia Kenya Mozambique Myanmar South Africa Peru Philippines USA Brazil France Italy Canada Pakistan Spain Vietnam Japan Iran Bangladesh Ethiopia Ghana Germany Mexico South Korea United Kingdom Saudi Arabia Algeria Morocco Yemen Poland Thailand Uganda Egypt Nigeria Taiwan Fiji Zambia Dominican Rep. Bolivia Cรดte d'Ivoire Eritrea Togo Sri Lanka Bulgaria Greece Slovakia New Zealand Trinidad and Tobago Mongolia Czechia Belarus Israel North Macedonia Hong Kong Qatar Panama Serbia Benin Burundi CAR Syria China favored low-cost treatments.The average efficacy was moderate.Low-cost protocols improve early treatment,and add complementary/synergistic benefits. More effective More expensive 75% 50% 25% โ‰ค0%
Disease Progression of Hospitalized Elderly Patients with Omicron BA.2 Treated with Molnupiravir
Yayun Liu, Lingling Ge, Shiyong Fan, Aijing Xu, Xinyu Wang, Xu Dong, Mingxiao Xu, Wenhan Fan, Wu Zhong, Xuesong Liang
Infectious Diseases and Therapy, doi:10.1007/s40121-022-00716-7
Introduction: The efficacy of molnupiravir (MLN) on Omicron sublineages is limited. We investigated the effectiveness of MLN in older adults diagnosed with Omicron BA.2. Methods: Data of elderly COVID-19 patients (over 60 years) admitted to Chinghai Hospital (Shanghai, China) from 26 March to 31 May 2022 were reviewed. Study outcomes were a composite of undetectable viral load (VL) and disease progression [all-cause mortality, initiation of oxygen supply through high-flow device or invasive mechanical ventilation (IMV), or intensive care unit (ICU) admission] and their individual outcomes. Results: A total of 42 elderly patients were enrolled: 26 of them received MLN, 17 (40.5%) were males, the median age was 84 years, and 12 were fully vaccinated (31.0%). Among these elderly COVID-19 patients, five (11.90%) experienced obvious dyspnea or were transferred to ICU [three MLN users (11.5%) versus two non-MLN users (12.5%)]. Compared with no MLN use, MLN use was associated with rapid undetectable VL. At day 10, MLN users achieved Yayun Liu, Lingling Ge, and Shiyong Fan are co-first authors.
Author Contributions. Yayun Liu recruited the patients and collected specimens, edited the clinical data and performed the data analysis; Lingling Ge edited the clinical data of enrolled patients; Shiyong Fan drafted the manuscript; Aijing Xu recruited the patients and treated the patients; Wang, Xu Dong, Mingxiao Xu and Wenhan Fan treated the patients; Wu Zhong conceived and designed the study; Xuesong Liang conceived and designed the study; checked the data analysis and drafted the manuscript; All authors have read and approved the final manuscript. Disclosures. Yayun Liu, Lingling Ge, Shiyong Fan, Aijing Xu, Xinyu Wang, XuDong, Mingxiao Xu, Wenhan Fan, Wu Zhong and Xuesong Liang declare that they have no competing interests. Compliance with Ethics Guidelines. This study was approved by the Ethics Committee of Changhai Hospital. (CHEC2022-111).Written informed consent was exempted from all the study participants. This study was performed in accordance with the Helsinki Declaration of 1964 and its later amendments. Data Availability. All data and analysis results are included in this article. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. All authors have read and approved the final manuscript. Open Access. This article is licensed under a Creative Commons Attribution-Non-Commercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction..
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