Molnupiravir: meta-analysis of COVID-19 studies

Meta-analysis of molnupiravir COVID-19 studies. Potential risks include the creation of dangerous variants, and mutagenicity, carcinogenicity, teratogenicity, and embryotoxicity1-15. Multiple analyses have identified variants potentially created by molnupiravir16-20. There is substantial publication bias. Multiple trials have not reported results and did not respond to requests21. Studies show significantly increased risk of acute kidney injury22, cardiovascular toxocity23, and neurological symptoms22. Treatment may increase viral rebound24,25.

All studies Exclusions Mortality Ventilation ICU Hospitalization Serious outcomes Recovery Cases Viral clearance RCTs RCT mortality RCT COI Peer-reviewed Long COVID All outcomes

Outcome (studies)

Improvement

Relative risk · 95% CI

All studies (54)5%

Mortality (29)9%

Ventilation (9)11%

ICU admission (9)3%

Hospitalization (25)0%

Progression (7)29%

Recovery (13)6%

Cases (1)24%

Viral clearance (16)19%

RCTs (19)16%

RCT mortality (6)1%

Manufacturer (8)54%

Other (11)−6%

Prophylaxis (1)24%

Early (44)4%

Late (9)11%

after exclusions

00.511.5+

← Molnupiravir
reduces riskIncreased
risk →

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c19early.org

October 2026

Molnupiravir COVID-19 studies

StudyImprovementRR · 95% CIOutcomeTreatmentControlRelative Risk

Fischer (RCT)77%0.23 · 0.01–5.69death0/1401/62 Hetero (RCT)70%0.30 · 0.13–0.70hosp.7/37123/370licensee Khoo (RCT)−33%1.33 · 0.55–3.26no recov.8/123/6 Optimus (RCT)75%0.25 · 0.03–2.22hosp.1/6034/599licensee Jayk Ber.. (DB RCT)89%0.11 · 0.01–0.86death1/7099/699MOVe-OUT Caraco (DB RCT)67%0.33 · 0.01–8.05death0/741/74MOVe-OUT Phase 2 Tippabhotla (RCT)46%0.54 · 0.22–1.34hosp.7/61013/610 Gleeson−129%2.29 · 0.15–34.84death1/211/48 Wong (PSM)52%0.48 · 0.40–0.59death1,856 (n)1,856 (n) Yip (PSW)−12%1.12 · 0.68–1.82death/ICU Zou (RCT)29%0.71 · 0.28–1.85recov. time77 (n)31 (n) Flisiak39%0.61 · 0.38–0.97death20/20363/387 Khoo (DB RCT)67%0.33 · 0.01–8.08oxygen0/901/90AGILE CST-2 Kneidinger−15%1.15 · 0.56–2.37severe case8/4626/172 Najjar-Deb.. (PSM)19%0.81 · 0.46–1.43death22/2,66127/2,661 Arbel 65+74%0.26 · 0.10–0.73death4/845137/12,724 Arbel 40-64−1182%12.82 · 3.41–48.17death4/2247/6,075 Suzuki (PSM)−100%2.00 · 0.34–11.90death2/2303/690 Brown−101%2.01 · 0.43–9.38hosp.8/4422/222 Butler (RCT)−27%1.27 · 0.65–2.48death20/11,77815/11,230PANORAMIC Wong (PSM)24%0.76 · 0.61–0.95death Liu−162%2.62 · 0.11–60.58ICU1/260/16 Sinha (RCT)65%0.35 · 0.16–0.73hosp.9/60826/610licensee Zheng−100%2.00 · 1.23–3.23death/hosp.61/2,68934/3,331OT¹ Bajema (PSM)18%0.82 · 0.52–1.29death24/89729/897 Inaba58%0.42 · 0.02–10.13death0/841/210 Zheng (PSW)−285%3.85 · 1.54–10.00death/hosp.11/80233/4,836OT¹ Evans51%0.49 · 0.29–0.83death/hosp.359 (n)4,973 (n) Goodwin−110%2.10 · 0.19–22.87death1/802/336 Tazare−9%1.09 · 0.93–1.27death/hosp. Butt−9%1.09 · 0.73–1.63death/hosp.48/1,45944/1,459 Fung4%0.96 · 0.93–0.99PASCpopulation-based cohortLONG COVID Tare (RCT)−83%1.83 · 0.69–4.82no recov.4/75/16DAWN Cheng15%0.85 · 0.77–0.95death4,146 (n)5,792 (n) Standing (RCT)−103%2.03 · 0.52–7.94viral+6/1173/119 Razia−272%3.72 · 0.35–39.35death2/291/54 Yen18%0.82 · 0.50–1.33death250 (n)1,946 (n) Gentile (PSM)4%0.96 · 0.70–1.31deathcase-control studySAVALO Jorda (PSM)−27%1.27 · 0.65–2.49death14/10,75221/21,504 Wei3%0.97 · 0.82–1.17death Zou−32%1.32 · 0.89–1.97viral+26/12584/535 Khoo (RCT)−1%1.01 · 0.73–1.42viral load16 (n)8 (n)AGILE CST-8CT² Hong Choi (PSW)−61%1.61 · 1.30–2.00death Şimşek-Ya.. (PSM)−200%3.00 · 0.31–28.84progression3/2041/204

Early treatment4%0.96 · 0.85–1.09323/43,642620/85,4524% lower risk

Tau² = 0.06, I² = 76.6%, p = 0.58

033864 (RCT)0%1.00 · 0.50–2.00improv.n/an/aFUTILITY, PENDING³ 035424 (RCT)0%1.00 · 0.50–2.00improv.n/an/aFUTILITY, PENDING³ Arribas (DB RCT)−282%3.82 · 0.50–29.09death11/2161/75MOVe-IN Wan11%0.89 · 0.81–0.98death704/6,1532,541/17,283 Wan13%0.87 · 0.81–0.93death2,700 (n)13,795 (n) Özdemir−50%1.50 · 0.27–8.49death3/392/39 Horby (RCT)−11%1.11 · 0.79–1.58death57/44555/478RECOVERY Lv−53%1.53 · 0.83–2.83death12/6730/257 Lai10%0.90 · 0.83–0.97death4,975 (n)8,667 (n)

Late treatment11%0.89 · 0.85–0.93787/14,5952,629/40,59411% lower risk

Tau² = 0.00, I² = 0.0%, p < 0.0001

Alpizar (DB RCT)24%0.76 · 0.58–1.00symp. case78/763103/764MOVe-AHEAD

Prophylaxis24%0.76 · 0.58–1.0078/763103/76424% lower risk

Tau² = 0.00, I² = 0.0%, p = 0.049

All studies5%0.95 · 0.88–1.031,188/59,0003,352/126K5% lower risk

Tau² = 0.03, I² = 73.7%, p = 0.2200.511.52+

¹ OT: comparison with other treatment

² CT: study uses combined treatment

³ FUTILITY: terminated for futility, results pending

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October 2026

Molnupiravir COVID-19 studies after exclusions

StudyImprovementRR · 95% CIOutcomeTreatmentControlRelative Risk

Fischer (RCT)77%0.23 · 0.01–5.69death0/1401/62 Hetero (RCT)70%0.30 · 0.13–0.70hosp.7/37123/370licensee Khoo (RCT)−33%1.33 · 0.55–3.26no recov.8/123/6 Optimus (RCT)75%0.25 · 0.03–2.22hosp.1/6034/599licensee Jayk Ber.. (DB RCT)89%0.11 · 0.01–0.86death1/7099/699MOVe-OUT Caraco (DB RCT)67%0.33 · 0.01–8.05death0/741/74MOVe-OUT Phase 2 Tippabhotla (RCT)46%0.54 · 0.22–1.34hosp.7/61013/610 Gleeson−129%2.29 · 0.15–34.84death1/211/48 Wong (PSM)52%0.48 · 0.40–0.59death1,856 (n)1,856 (n) Yip (PSW)−12%1.12 · 0.68–1.82death/ICU Zou (RCT)29%0.71 · 0.28–1.85recov. time77 (n)31 (n) Flisiak39%0.61 · 0.38–0.97death20/20363/387 Khoo (DB RCT)67%0.33 · 0.01–8.08oxygen0/901/90AGILE CST-2 Kneidinger−15%1.15 · 0.56–2.37severe case8/4626/172 Najjar-Deb.. (PSM)19%0.81 · 0.46–1.43death22/2,66127/2,661 Arbel 65+74%0.26 · 0.10–0.73death4/845137/12,724 Arbel 40-64−1182%12.82 · 3.41–48.17death4/2247/6,075 Suzuki (PSM)−100%2.00 · 0.34–11.90death2/2303/690 Butler (RCT)−27%1.27 · 0.65–2.48death20/11,77815/11,230PANORAMIC Wong (PSM)24%0.76 · 0.61–0.95death Liu−162%2.62 · 0.11–60.58ICU1/260/16 Sinha (RCT)65%0.35 · 0.16–0.73hosp.9/60826/610licensee Zheng−100%2.00 · 1.23–3.23death/hosp.61/2,68934/3,331OT¹ Bajema (PSM)18%0.82 · 0.52–1.29death24/89729/897 Inaba58%0.42 · 0.02–10.13death0/841/210 Evans51%0.49 · 0.29–0.83death/hosp.359 (n)4,973 (n) Goodwin−110%2.10 · 0.19–22.87death1/802/336 Tazare−9%1.09 · 0.93–1.27death/hosp. Butt−9%1.09 · 0.73–1.63death/hosp.48/1,45944/1,459 Fung4%0.96 · 0.93–0.99PASCpopulation-based cohortLONG COVID Tare (RCT)−83%1.83 · 0.69–4.82no recov.4/75/16DAWN Cheng15%0.85 · 0.77–0.95death4,146 (n)5,792 (n) Standing (RCT)−103%2.03 · 0.52–7.94viral+6/1173/119 Razia−272%3.72 · 0.35–39.35death2/291/54 Yen18%0.82 · 0.50–1.33death250 (n)1,946 (n) Gentile (PSM)4%0.96 · 0.70–1.31deathcase-control studySAVALO Jorda (PSM)−27%1.27 · 0.65–2.49death14/10,75221/21,504 Wei3%0.97 · 0.82–1.17death Khoo (RCT)−1%1.01 · 0.73–1.42viral load16 (n)8 (n)AGILE CST-8CT² Şimşek-Ya.. (PSM)−200%3.00 · 0.31–28.84progression3/2041/204

Early treatment11%0.89 · 0.79–1.00278/42,273501/79,85911% lower risk

Tau² = 0.05, I² = 72.3%, p = 0.056

Late treatment11%0.89 · 0.85–0.93787/14,5952,629/40,59411% lower risk

Tau² = 0.00, I² = 0.0%, p < 0.0001

Alpizar (DB RCT)24%0.76 · 0.58–1.00symp. case78/763103/764MOVe-AHEAD

Prophylaxis24%0.76 · 0.58–1.0078/763103/76424% lower risk

Tau² = 0.00, I² = 0.0%, p = 0.049

All studies10%0.90 · 0.83–0.971,143/57,6313,233/121K10% lower risk

Tau² = 0.02, I² = 68.7%, p = 0.006800.511.52+

¹ OT: comparison with other treatment

² CT: study uses combined treatment

³ FUTILITY: terminated for futility, results pending

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October 2026

Molnupiravir COVID-19 mortality results

StudyImprovementRR · 95% CITreatmentControlRelative Risk

Fischer (RCT)77%0.23 · 0.01–5.690/1401/62 Jayk Ber.. (DB RCT)89%0.11 · 0.01–0.861/7099/699MOVe-OUT Caraco (DB RCT)67%0.33 · 0.01–8.050/741/74MOVe-OUT Phase 2 Gleeson−129%2.29 · 0.15–34.841/211/48 Wong (PSM)52%0.48 · 0.40–0.591,856 (n)1,856 (n) Flisiak39%0.61 · 0.38–0.9720/20363/387 Najjar-Deb.. (PSM)19%0.81 · 0.46–1.4322/2,66127/2,661 Arbel 65+74%0.26 · 0.10–0.734/845137/12,724 Arbel 40-64−1182%12.82 · 3.41–48.174/2247/6,075 Suzuki (PSM)−100%2.00 · 0.34–11.902/2303/690 Butler (RCT)−27%1.27 · 0.65–2.4820/11,77815/11,230PANORAMIC Wong (PSM)24%0.76 · 0.61–0.95 Bajema (PSM)18%0.82 · 0.52–1.2924/89729/897 Inaba58%0.42 · 0.02–10.130/841/210 Goodwin−110%2.10 · 0.19–22.871/802/336 Cheng15%0.85 · 0.77–0.954,146 (n)5,792 (n) Razia−272%3.72 · 0.35–39.352/291/54 Yen18%0.82 · 0.50–1.33250 (n)1,946 (n) Gentile (PSM)4%0.96 · 0.70–1.31case-control studySAVALO Jorda (PSM)−27%1.27 · 0.65–2.4914/10,75221/21,504 Wei3%0.97 · 0.82–1.17 Hong Choi (PSW)−61%1.61 · 1.30–2.00

Early treatment10%0.90 · 0.72–1.12115/34,979318/67,24510% lower risk

Tau² = 0.13, I² = 80.6%, p = 0.36

Arribas (DB RCT)−282%3.82 · 0.50–29.0911/2161/75MOVe-IN Wan11%0.89 · 0.81–0.98704/6,1532,541/17,283 Wan13%0.87 · 0.81–0.932,700 (n)13,795 (n) Özdemir−50%1.50 · 0.27–8.493/392/39 Horby (RCT)−11%1.11 · 0.79–1.5857/44555/478RECOVERY Lv−53%1.53 · 0.83–2.8312/6730/257 Lai10%0.90 · 0.83–0.974,975 (n)8,667 (n)

Late treatment11%0.89 · 0.85–0.95787/14,5952,629/40,59411% lower risk

Tau² = 0.00, I² = 18.8%, p < 0.0001

All studies9%0.91 · 0.81–1.02902/49,5742,947/107K9% lower risk

Tau² = 0.04, I² = 75.9%, p = 0.1100.511.52+

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October 2026

Molnupiravir COVID-19 mechanical ventilation results

StudyImprovementRR · 95% CITreatmentControlRelative Risk

Wong (PSM)58%0.42 · 0.17–1.011,856 (n)1,856 (n) Flisiak5%0.95 · 0.39–2.327/20314/387 Suzuki (PSM)57%0.43 · 0.02–10.480/2301/690 Wong (PSM)60%0.40 · 0.19–0.84 Bajema (PSM)17%0.83 · 0.17–4.123/8973/897 Razia−86%1.86 · 0.12–28.691/291/54 Hong Choi (PSW)−12%1.12 · 0.68–1.85

Early treatment28%0.72 · 0.48–1.1011/3,21519/3,88428% lower risk

Tau² = 0.07, I² = 21.6%, p = 0.13

Wan−7%1.07 · 0.89–1.302,700 (n)13,795 (n) Horby (RCT)−43%1.43 · 0.50–4.088/4456/476RECOVERY

Late treatment−8%1.08 · 0.90–1.308/3,1456/14,2718% higher risk

Tau² = 0.00, I² = 0.0%, p = 0.43

All studies11%0.89 · 0.66–1.1919/6,36025/18,15511% lower risk

Tau² = 0.05, I² = 27.9%, p = 0.4300.511.52+

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October 2026

Molnupiravir COVID-19 ICU results

StudyImprovementRR · 95% CITreatmentControlRelative Risk

Gleeson−129%2.29 · 0.15–34.841/211/48 Wong (PSM)26%0.74 · 0.45–1.21 Liu−162%2.62 · 0.11–60.581/260/16 Bajema (PSM)1%0.99 · 0.41–2.3710/89710/897 Cheng12%0.88 · 0.59–1.304,146 (n)5,792 (n) Razia−86%1.86 · 0.28–12.542/292/54 Hong Choi (PSW)−28%1.28 · 0.68–2.38

Early treatment7%0.93 · 0.72–1.2114/5,11913/6,8077% lower risk

Tau² = 0.00, I² = 0.0%, p = 0.6

Wan−2%1.02 · 0.76–1.362,700 (n)13,795 (n) Özdemir0%1.00 · 0.15–6.752/392/39

Late treatment−2%1.02 · 0.76–1.362/2,7392/13,8342% higher risk

Tau² = 0.00, I² = 0.0%, p = 0.9

All studies3%0.97 · 0.80–1.1816/7,85815/20,6413% lower risk

Tau² = 0.00, I² = 0.0%, p = 0.7700.511.52+

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October 2026

Molnupiravir COVID-19 hospitalization results

StudyImprovementRR · 95% CIOutcomeTreatmentControlRelative Risk

Fischer (RCT)−33%1.33 · 0.14–12.52hosp.3/1401/62 Hetero (RCT)70%0.30 · 0.13–0.70hosp.7/37123/370licensee Optimus (RCT)75%0.25 · 0.03–2.22hosp.1/6034/599licensee Caraco (DB RCT)25%0.75 · 0.17–3.24hosp.3/744/74MOVe-OUT Phase 2 Tippabhotla (RCT)46%0.54 · 0.22–1.34hosp.7/61013/610 Gleeson31%0.69 · 0.21–2.24hosp.3/2110/48 Wong (PSM)6%0.94 · 0.89–1.00hosp. time1,856 (n)1,856 (n) Yip (PSW)−17%1.17 · 0.99–1.39hosp. Flisiak−1%1.01 · 0.71–1.43hosp. time203 (n)387 (n) Khoo (DB RCT)89%0.11 · 0.01–2.03hosp.0/904/90AGILE CST-2 Arbel 65+45%0.55 · 0.34–0.88hosp.18/845513/12,724 Arbel 40-64−80%1.80 · 0.86–3.77hosp.8/22497/6,075 Brown−101%2.01 · 0.43–9.38hosp.8/4422/222 Butler (RCT)−7%1.07 · 0.81–1.41hosp.103/12,52996/12,525PANORAMIC Wong (PSM)2%0.98 · 0.89–1.06hosp. Liu18%0.82 · 0.63–1.06hosp. time26 (n)16 (n) Sinha (RCT)65%0.35 · 0.16–0.73hosp.9/60826/610licensee Bajema (PSM)−30%1.30 · 1.01–1.68hosp.162/897124/897 Inaba−127%2.27 · 0.60–7.25hosp.5/848/210 Goodwin58%0.42 · 0.05–3.23hosp.1/8010/336 Razia28%0.72 · 0.28–1.81hosp.5/2913/54 Gentile (PSM)26%0.74 · 0.13–4.18hosp.case-control studySAVALO Jorda (PSM)−1%1.01 · 0.83–1.23hosp.150/10,752297/21,504 Wei−8%1.08 · 1.03–1.13hosp.

Early treatment1%0.99 · 0.91–1.08493/30,4841,245/59,2691% lower risk

Tau² = 0.01, I² = 64.8%, p = 0.82

Wan1%0.99 · 0.93–1.05hosp.2,298/6,1532,541/17,283

Late treatment1%0.99 · 0.94–1.042,298/6,1532,541/17,2831% lower risk

Tau² = 0.00, I² = 0.0%, p = 0.7

All studies0%1.00 · 0.93–1.072,791/36,6373,786/76,5520% lower risk

Tau² = 0.01, I² = 63.9%, p = 0.9300.511.52+

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October 2026

Molnupiravir COVID-19 serious outcomes

StudyImprovementRR · 95% CIOutcomeTreatmentControlRelative Risk

Fischer (RCT)77%0.23 · 0.01–5.69death0/1401/62 Hetero (RCT)70%0.30 · 0.13–0.70hosp.7/37123/370licensee Optimus (RCT)75%0.25 · 0.03–2.22hosp.1/6034/599licensee Jayk Ber.. (DB RCT)89%0.11 · 0.01–0.86death1/7099/699MOVe-OUT Caraco (DB RCT)67%0.33 · 0.01–8.05death0/741/74MOVe-OUT Phase 2 Tippabhotla (RCT)46%0.54 · 0.22–1.34hosp.7/61013/610 Gleeson−129%2.29 · 0.15–34.84death1/211/48 Wong (PSM)52%0.48 · 0.40–0.59death1,856 (n)1,856 (n) Yip (PSW)−12%1.12 · 0.68–1.82death/ICU Flisiak39%0.61 · 0.38–0.97death20/20363/387 Khoo (DB RCT)67%0.33 · 0.01–8.08oxygen0/901/90AGILE CST-2 Kneidinger−15%1.15 · 0.56–2.37severe case8/4626/172 Najjar-Deb.. (PSM)19%0.81 · 0.46–1.43death22/2,66127/2,661 Arbel 65+74%0.26 · 0.10–0.73death4/845137/12,724 Arbel 40-64−1182%12.82 · 3.41–48.17death4/2247/6,075 Suzuki (PSM)−100%2.00 · 0.34–11.90death2/2303/690 Brown−101%2.01 · 0.43–9.38hosp.8/4422/222 Butler (RCT)−27%1.27 · 0.65–2.48death20/11,77815/11,230PANORAMIC Wong (PSM)24%0.76 · 0.61–0.95death Liu−162%2.62 · 0.11–60.58ICU1/260/16 Sinha (RCT)65%0.35 · 0.16–0.73hosp.9/60826/610licensee Zheng−100%2.00 · 1.23–3.23death/hosp.61/2,68934/3,331OT¹ Bajema (PSM)18%0.82 · 0.52–1.29death24/89729/897 Inaba58%0.42 · 0.02–10.13death0/841/210 Zheng (PSW)−285%3.85 · 1.54–10.00death/hosp.11/80233/4,836OT¹ Evans51%0.49 · 0.29–0.83death/hosp.359 (n)4,973 (n) Goodwin−110%2.10 · 0.19–22.87death1/802/336 Tazare−9%1.09 · 0.93–1.27death/hosp. Butt−9%1.09 · 0.73–1.63death/hosp.48/1,45944/1,459 Fung4%0.96 · 0.93–0.99PASCpopulation-based cohortLONG COVID Cheng15%0.85 · 0.77–0.95death4,146 (n)5,792 (n) Razia−272%3.72 · 0.35–39.35death2/291/54 Yen18%0.82 · 0.50–1.33death250 (n)1,946 (n) Gentile (PSM)4%0.96 · 0.70–1.31deathcase-control studySAVALO Jorda (PSM)−27%1.27 · 0.65–2.49death14/10,75221/21,504 Wei3%0.97 · 0.82–1.17death Hong Choi (PSW)−61%1.61 · 1.30–2.00death Şimşek-Ya.. (PSM)−200%3.00 · 0.31–28.84progression3/2041/204

Early treatment7%0.93 · 0.82–1.07279/43,288525/84,7377% lower risk

Tau² = 0.07, I² = 79.1%, p = 0.32

Arribas (DB RCT)−282%3.82 · 0.50–29.09death11/2161/75MOVe-IN Wan11%0.89 · 0.81–0.98death704/6,1532,541/17,283 Wan13%0.87 · 0.81–0.93death2,700 (n)13,795 (n) Özdemir−50%1.50 · 0.27–8.49death3/392/39 Horby (RCT)−11%1.11 · 0.79–1.58death57/44555/478RECOVERY Lv−53%1.53 · 0.83–2.83death12/6730/257 Lai10%0.90 · 0.83–0.97death4,975 (n)8,667 (n)

Late treatment11%0.89 · 0.85–0.95787/14,5952,629/40,59411% lower risk

Tau² = 0.00, I² = 18.8%, p < 0.0001

All studies6%0.94 · 0.86–1.031,066/57,8833,154/125K6% lower risk

Tau² = 0.03, I² = 77.1%, p = 0.1700.511.52+

¹ OT: comparison with other treatment

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October 2026

Molnupiravir COVID-19 recovery results

StudyImprovementRR · 95% CIOutcomeTreatmentControlRelative Risk

Hetero (RCT)33%0.67 · 0.54–0.82recov. time371 (n)370 (n)licensee Khoo (RCT)−33%1.33 · 0.55–3.26no recov.8/123/6 Optimus (RCT)−15%1.15 · 1.02–1.31no recov.286/603246/599licensee Jayk Ber.. (DB RCT)15%0.85 · 0.75–0.98recovery709 (n)699 (n)MOVe-OUT Caraco (DB RCT)−22%1.22 · 0.56–2.63no recov.74 (n)74 (n)MOVe-OUT Phase 2 Zou (RCT)29%0.71 · 0.28–1.85recov. time77 (n)31 (n) Khoo (DB RCT)−12%1.12 · 0.71–1.79no recov.27/9024/90AGILE CST-2 Butler (RCT)22%0.78 · 0.75–0.81no recov.3,856/12,4034,838/12,140PANORAMIC Tare (RCT)−83%1.83 · 0.69–4.82no recov.4/75/16DAWN

Early treatment9%0.91 · 0.77–1.094,181/14,3465,116/14,0259% lower risk

Tau² = 0.04, I² = 82.3%, p = 0.31

033864 (RCT)0%1.00 · 0.50–2.00improv.n/an/aFUTILITY, PENDING¹ 035424 (RCT)0%1.00 · 0.50–2.00improv.n/an/aFUTILITY, PENDING¹ Arribas (DB RCT)1%0.99 · 0.68–1.45no recov.72 (n)75 (n)MOVe-IN Horby (RCT)−9%1.09 · 0.88–1.35no disch.126/445124/478RECOVERY

Late treatment−6%1.06 · 0.89–1.26126/517124/5536% higher risk

Tau² = 0.00, I² = 0.0%, p = 0.53

All studies6%0.94 · 0.82–1.094,307/14,8635,240/14,5786% lower risk

Tau² = 0.03, I² = 78.2%, p = 0.4400.511.52+

¹ FUTILITY: terminated for futility, results pending

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October 2026

Molnupiravir COVID-19 case results

StudyImprovementRR · 95% CIOutcomeTreatmentControlRelative Risk

Alpizar (DB RCT)24%0.76 · 0.58–1.00symp. case78/763103/764MOVe-AHEAD

Prophylaxis24%0.76 · 0.58–1.0078/763103/76424% lower risk

Tau² = 0.00, I² = 0.0%, p = 0.049

All studies24%0.76 · 0.58–1.0078/763103/76424% lower risk

Tau² = 0.00, I² = 0.0%, p = 0.04900.511.52+

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October 2026

Molnupiravir COVID-19 viral clearance results

StudyImprovementRR · 95% CIOutcomeTreatmentControlRelative Risk

Fischer (RCT)49%0.51 · 0.22–1.18viral+10/1189/54 Optimus (RCT)41%0.59 · 0.51–0.69viral+174/603291/599licensee Jayk Ber.. (DB RCT)4%0.96 · 0.90–1.02viral load518 (n)510 (n)MOVe-OUT Tippabhotla (RCT)59%0.41 · 0.29–0.57viral+42/610103/610 Wong (PSM)28%0.72 · 0.61–0.87viral+1,856 (n)1,856 (n) Zou (RCT)10%0.90 · 0.83–0.97viral time76 (n)31 (n) Khoo (DB RCT)23%0.77 · 0.58–1.09viral+90 (n)90 (n)AGILE CST-2 Butler (RCT)−95%1.95 · 1.15–3.31viral load21 (n)11 (n)PANORAMIC Liu21%0.79 · 0.59–1.05viral time26 (n)16 (n) Sinha (RCT)48%0.52 · 0.42–0.63viral load608 (n)610 (n)licensee Standing (RCT)−103%2.03 · 0.52–7.94viral+6/1173/119 Zou−32%1.32 · 0.89–1.97viral+26/12584/535 Khoo (RCT)−1%1.01 · 0.73–1.42viral load16 (n)8 (n)AGILE CST-8CT¹ Şimşek-Yavuz−41%1.41 · 0.72–2.78viral load48 (n)24 (n)

Early treatment19%0.81 · 0.69–0.95258/4,832490/5,07319% lower risk

Tau² = 0.06, I² = 87.4%, p = 0.0088

Arribas (DB RCT)12%0.88 · 0.62–1.25viral+26/5234/60MOVe-IN Horby (RCT)12%0.88 · 0.85–0.91viral load445 (n)478 (n)RECOVERY

Late treatment12%0.88 · 0.85–0.9126/49734/53812% lower risk

Tau² = 0.00, I² = 0.0%, p < 0.0001

All studies19%0.81 · 0.72–0.90284/5,329524/5,61119% lower risk

Tau² = 0.03, I² = 85.7%, p = 0.0002200.511.52+

¹ CT: study uses combined treatment

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October 2026

Molnupiravir COVID-19 Randomized Controlled Trials

StudyImprovementRR · 95% CIOutcomeTreatmentControlRelative Risk

Early treatment28%0.72 · 0.49–1.0763/15,212104/14,52428% lower risk

Tau² = 0.22, I² = 50.2%, p = 0.1

033864 (RCT)0%1.00 · 0.50–2.00improv.n/an/aFUTILITY, PENDING² 035424 (RCT)0%1.00 · 0.50–2.00improv.n/an/aFUTILITY, PENDING² Arribas (DB RCT)−282%3.82 · 0.50–29.09death11/2161/75MOVe-IN Horby (RCT)−11%1.11 · 0.79–1.58death57/44555/478RECOVERY

Late treatment−10%1.10 · 0.83–1.4668/66156/55310% higher risk

Tau² = 0.00, I² = 0.0%, p = 0.51

Alpizar (DB RCT)24%0.76 · 0.58–1.00symp. case78/763103/764MOVe-AHEAD

Prophylaxis24%0.76 · 0.58–1.0078/763103/76424% lower risk

Tau² = 0.00, I² = 0.0%, p = 0.049

All studies16%0.84 · 0.66–1.07209/16,636263/15,84116% lower risk

Tau² = 0.09, I² = 42.9%, p = 0.1600.511.52+

¹ CT: study uses combined treatment

² FUTILITY: terminated for futility, results pending

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October 2026

Molnupiravir COVID-19 RCT mortality results

StudyImprovementRR · 95% CITreatmentControlRelative Risk

Fischer (RCT)77%0.23 · 0.01–5.690/1401/62 Jayk Ber.. (DB RCT)89%0.11 · 0.01–0.861/7099/699MOVe-OUT Caraco (DB RCT)67%0.33 · 0.01–8.050/741/74MOVe-OUT Phase 2 Butler (RCT)−27%1.27 · 0.65–2.4820/11,77815/11,230PANORAMIC

Early treatment55%0.45 · 0.11–1.8721/12,70126/12,06555% lower risk

Tau² = 1.05, I² = 50.7%, p = 0.27

Arribas (DB RCT)−282%3.82 · 0.50–29.0911/2161/75MOVe-IN Horby (RCT)−11%1.11 · 0.79–1.5857/44555/478RECOVERY

Late treatment−35%1.35 · 0.56–3.2668/66156/55335% higher risk

Tau² = 0.21, I² = 27.3%, p = 0.51

All studies1%0.99 · 0.55–1.7889/13,36282/12,6181% lower risk

Tau² = 0.16, I² = 36.5%, p = 0.9700.511.52+

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October 2026

Molnupiravir COVID-19 manufacturer vs. other RCTs

StudyImprovementRR · 95% CIOutcomeTreatmentControlRelative Risk

Manufacturer54%0.46 · 0.25–0.83107/3,484168/3,25354% lower risk

Tau² = 0.27, I² = 50.4%, p = 0.0095

Khoo (RCT)−33%1.33 · 0.55–3.26no recov.8/123/6 033864 (RCT)0%1.00 · 0.50–2.00improv.n/an/aFUTILITY, PENDING² 035424 (RCT)0%1.00 · 0.50–2.00improv.n/an/aFUTILITY, PENDING² Tippabhotla (RCT)46%0.54 · 0.22–1.34hosp.7/61013/610 Zou (RCT)29%0.71 · 0.28–1.85recov. time77 (n)31 (n) Khoo (DB RCT)67%0.33 · 0.01–8.08oxygen0/901/90AGILE CST-2 Butler (RCT)−27%1.27 · 0.65–2.48death20/11,77815/11,230PANORAMIC Tare (RCT)−83%1.83 · 0.69–4.82no recov.4/75/16DAWN Standing (RCT)−103%2.03 · 0.52–7.94viral+6/1173/119 Horby (RCT)−11%1.11 · 0.79–1.58death57/44555/478RECOVERY Khoo (RCT)−1%1.01 · 0.73–1.42viral load16 (n)8 (n)AGILE CST-8CT¹

Non-manufacturer−6%1.06 · 0.88–1.28102/13,15295/12,5886% higher risk

Tau² = 0.00, I² = 0.0%, p = 0.54

All studies16%0.84 · 0.66–1.07209/16,636263/15,84116% lower risk

00.511.52+

¹ CT: study uses combined treatment

² FUTILITY: terminated for futility, results pending

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October 2026

Molnupiravir COVID-19 peer reviewed studies

StudyImprovementRR · 95% CIOutcomeTreatmentControlRelative Risk

Hetero (RCT)70%0.30 · 0.13–0.70hosp.7/37123/370licensee Khoo (RCT)−33%1.33 · 0.55–3.26no recov.8/123/6 Jayk Ber.. (DB RCT)89%0.11 · 0.01–0.86death1/7099/699MOVe-OUT Caraco (DB RCT)67%0.33 · 0.01–8.05death0/741/74MOVe-OUT Phase 2 Tippabhotla (RCT)46%0.54 · 0.22–1.34hosp.7/61013/610 Wong (PSM)52%0.48 · 0.40–0.59death1,856 (n)1,856 (n) Yip (PSW)−12%1.12 · 0.68–1.82death/ICU Zou (RCT)29%0.71 · 0.28–1.85recov. time77 (n)31 (n) Flisiak39%0.61 · 0.38–0.97death20/20363/387 Khoo (DB RCT)67%0.33 · 0.01–8.08oxygen0/901/90AGILE CST-2 Kneidinger−15%1.15 · 0.56–2.37severe case8/4626/172 Najjar-Deb.. (PSM)19%0.81 · 0.46–1.43death22/2,66127/2,661 Suzuki (PSM)−100%2.00 · 0.34–11.90death2/2303/690 Brown−101%2.01 · 0.43–9.38hosp.8/4422/222 Butler (RCT)−27%1.27 · 0.65–2.48death20/11,77815/11,230PANORAMIC Wong (PSM)24%0.76 · 0.61–0.95death Liu−162%2.62 · 0.11–60.58ICU1/260/16 Sinha (RCT)65%0.35 · 0.16–0.73hosp.9/60826/610licensee Zheng−100%2.00 · 1.23–3.23death/hosp.61/2,68934/3,331OT¹ Evans51%0.49 · 0.29–0.83death/hosp.359 (n)4,973 (n) Goodwin−110%2.10 · 0.19–22.87death1/802/336 Butt−9%1.09 · 0.73–1.63death/hosp.48/1,45944/1,459 Fung4%0.96 · 0.93–0.99PASCpopulation-based cohortLONG COVID Tare (RCT)−83%1.83 · 0.69–4.82no recov.4/75/16DAWN Cheng15%0.85 · 0.77–0.95death4,146 (n)5,792 (n) Standing (RCT)−103%2.03 · 0.52–7.94viral+6/1173/119 Razia−272%3.72 · 0.35–39.35death2/291/54 Yen18%0.82 · 0.50–1.33death250 (n)1,946 (n) Gentile (PSM)4%0.96 · 0.70–1.31deathcase-control studySAVALO Jorda (PSM)−27%1.27 · 0.65–2.49death14/10,75221/21,504 Wei3%0.97 · 0.82–1.17death Zou−32%1.32 · 0.89–1.97viral+26/12584/535 Hong Choi (PSW)−61%1.61 · 1.30–2.00death Şimşek-Ya.. (PSM)−200%3.00 · 0.31–28.84progression3/2041/204

Early treatment7%0.93 · 0.81–1.05278/40,010407/59,9937% lower risk

Tau² = 0.06, I² = 76.0%, p = 0.24

Late treatment11%0.89 · 0.85–0.95787/14,5952,629/40,59411% lower risk

Tau² = 0.00, I² = 18.8%, p < 0.0001

Alpizar (DB RCT)24%0.76 · 0.58–1.00symp. case78/763103/764MOVe-AHEAD

Prophylaxis24%0.76 · 0.58–1.0078/763103/76424% lower risk

Tau² = 0.00, I² = 0.0%, p = 0.049

All studies8%0.92 · 0.85–1.001,143/55,3683,139/101K8% lower risk

Tau² = 0.02, I² = 73.3%, p = 0.05200.511.52+

¹ OT: comparison with other treatment

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October 2026

Molnupiravir COVID-19 long COVID results

StudyImprovementRR · 95% CIOutcomeTreatmentControlRelative Risk

Fung4%0.96 · 0.93–0.99PASCpopulation-based cohort Şimşek-Yavuz1%0.99 · 0.81–1.20PASC106/260127/307

Early treatment4%0.96 · 0.94–0.98106/260127/3074% lower risk

Tau² = 0.00, I² = 0.0%, p = 0.0011

All studies4%0.96 · 0.94–0.98106/260127/3074% lower risk

Tau² = 0.00, I² = 0.0%, p = 0.001100.511.52+

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Molnupiravir COVID-19 outcomes

StudyImprovementRR · 95% CIOutcomeTreatmentControlRelative Risk

00.511.52+

¹ OT: comparison with other treatment

² CT: study uses combined treatment

³ FUTILITY: terminated for futility, results pending

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Hadj Hassine et al., Lethal Mutagenesis of RNA Viruses and Approved Drugs with Antiviral Mutagenic Activity, Viruses, doi:10.3390/v14040841.mdpi.com, doi.org.

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