Outcomes in COVID-19 molnupiravir studies
Outcomes in molnupiravir studies.
Potential risks include the creation of dangerous variants and mutagenicity, carcinogenicity, teratogenicity, and embryotoxicity Hadj Hassine , Huntsman , Swanstrom , Waters , Zibat Multiple analyses have identified variants potentially created by molnupiravir
Fountain-Jones , Sanderson , twitter.com . There is substantial publication bias. Multiple trials have not reported results and did not respond to requests
Lawrence .
0 0.5 1 1.5+ All studies
15%
34
109,506
Improvement, Studies, Patients
Relative Risk Mortality
23%
15
83,307 Ventilation
46%
5
7,016 ICU admission
19%
3
1,836 Hospitalization
2%
18
79,431 Progression
25%
5
33,432 Recovery
19%
9
27,145 Cases
24%
1
1,527 Viral clearance
30%
10
7,150 RCTs
38%
14
32,322 RCT mortality
45%
4
26,955 Peer-reviewed
21%
24
81,355 Prophylaxis
24%
1
1,527 Early
16%
29
84,252 Late
11%
4
23,727
Molnupiravir for COVID-19
c19 early
Favors molnupiravir
Favors control
after exclusions
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Fischer (RCT)
77%
0.23 [0.01-5.69]
death
0/140
1/62
Improvement, RR [CI]
Treatment
Control Hetero (RCT)
70%
0.30 [0.13-0.70]
hosp.
7/371
23/370 Optimus (RCT)
58%
0.42 [0.31-0.58]
viral+
38/175
93/180 Khoo (RCT)
-33%
1.33 [0.55-3.26]
no recov.
8/12
3/6
MOVe-OUT Jayk Ber.. (DB RCT)
89%
0.11 [0.01-0.86]
death
1/709
9/699 Tippabhotla (RCT)
46%
0.54 [0.22-1.34]
hosp.
7/610
13/610 Wong (PSM)
52%
0.48 [0.40-0.59]
death
1,856 (n)
1,856 (n) Yip (PSW)
-12%
1.12 [0.68-1.82]
death/ICU Zou (RCT)
29%
0.71 [0.28-1.85]
recov. time
77 (n)
31 (n) Flisiak
39%
0.61 [0.38-0.97]
death
20/203
63/387
AGILE CST-2 Khoo (DB RCT)
67%
0.33 [0.01-8.08]
oxygen
0/90
1/90 Kneidinger
-15%
1.15 [0.56-2.37]
severe case
8/46
26/172 Najjar-Deb.. (PSM)
19%
0.81 [0.46-1.43]
death
22/2,661
27/2,661 Arbel 65+
74%
0.26 [0.10-0.73]
death
4/845
137/12,724 Arbel 40-64
-1182%
12.82 [3.41-48.2]
death
4/224
7/6,075 Suzuki (PSM)
-100%
2.00 [0.34-11.9]
death
2/230
3/690 Brown
-101%
2.01 [0.43-9.38]
hosp.
8/442
2/222
PANORAMIC Butler (RCT)
40%
0.60 [0.14-2.51]
death
3/12,529
5/12,525 Wong (PSM)
24%
0.76 [0.61-0.95]
death Liu
-162%
2.62 [0.11-60.6]
ICU
1/26
0/16 Sinha (RCT)
65%
0.35 [0.16-0.73]
hosp.
9/608
26/610 Zheng
-100%
2.00 [1.23-3.23]
death/hosp.
61/2,689
34/3,331
OT1 Bajema (PSM)
18%
0.82 [0.52-1.29]
death
24/897
29.0/897 Inaba
58%
0.42 [0.02-10.1]
death
0/84
1/210 Zheng (PSW)
-285%
3.85 [1.54-10.0]
death/hosp.
11/802
33/4,836
OT1 Evans
51%
0.49 [0.29-0.83]
death/hosp.
359 (n)
4,973 (n) Goodwin
-110%
2.10 [0.19-22.9]
death
1/80
2/336 Tazare
-9%
1.09 [0.93-1.27]
death/hosp. Butt
-9%
1.09 [0.73-1.63]
death/hosp.
48/1,459
44/1,459
Tau2 = 0.25, I2 = 81.9%, p = 0.16
Early treatment
16%
0.84 [0.65-1.07]
287/28,224
582.0/56,028
16% lower risk 033864 (RCT)
0%
1.00 [0.50-2.00]
improv.
n/a
n/a
FUTILITY, PENDING2
Improvement, RR [CI]
Treatment
Control 035424 (RCT)
0%
1.00 [0.50-2.00]
improv.
n/a
n/a
FUTILITY, PENDING2
MOVe-IN Arribas (DB RCT)
-282%
3.82 [0.50-29.1]
death
11/216
1/75 Wan
11%
0.89 [0.81-0.98]
death
704/6,153
2,541/17,283
Tau2 = 0.00, I2 = 0.0%, p = 0.0047
Late treatment
11%
0.89 [0.83-0.97]
715/6,369
2,542/17,358
11% lower risk
MOVe-AHEAD Alpizar (DB RCT)
24%
0.76 [0.57-1.01]
symp. case
78/763
103/764
Improvement, RR [CI]
Treatment
Control
Tau2 = 0.00, I2 = 0.0%, p = 0.049
Prophylaxis
24%
0.76 [0.57-1.01]
78/763
103/764
24% lower risk
All studies
15%
0.85 [0.71-1.02]
1,080/35,356
3,227.0/74,150
15% lower risk
34 molnupiravir COVID-19 studies
c19 early
Tau2 = 0.14, I2 = 79.4%, p = 0.076
Effect extraction pre-specified
1 OT: comparison with other treatment 2 FUTILITY: terminated for futility, results pending
Favors molnupiravir
Favors control
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Fischer (RCT)
77%
0.23 [0.01-5.69]
death
0/140
1/62
Improvement, RR [CI]
Treatment
Control Hetero (RCT)
70%
0.30 [0.13-0.70]
hosp.
7/371
23/370 Optimus (RCT)
58%
0.42 [0.31-0.58]
viral+
38/175
93/180 Khoo (RCT)
-33%
1.33 [0.55-3.26]
no recov.
8/12
3/6
MOVe-OUT Jayk Ber.. (DB RCT)
89%
0.11 [0.01-0.86]
death
1/709
9/699 Tippabhotla (RCT)
46%
0.54 [0.22-1.34]
hosp.
7/610
13/610 Wong (PSM)
52%
0.48 [0.40-0.59]
death
1,856 (n)
1,856 (n) Yip (PSW)
-12%
1.12 [0.68-1.82]
death/ICU Zou (RCT)
29%
0.71 [0.28-1.85]
recov. time
77 (n)
31 (n) Flisiak
39%
0.61 [0.38-0.97]
death
20/203
63/387
AGILE CST-2 Khoo (DB RCT)
67%
0.33 [0.01-8.08]
oxygen
0/90
1/90 Kneidinger
-15%
1.15 [0.56-2.37]
severe case
8/46
26/172 Najjar-Deb.. (PSM)
19%
0.81 [0.46-1.43]
death
22/2,661
27/2,661 Arbel 65+
74%
0.26 [0.10-0.73]
death
4/845
137/12,724 Arbel 40-64
-1182%
12.82 [3.41-48.2]
death
4/224
7/6,075 Suzuki (PSM)
-100%
2.00 [0.34-11.9]
death
2/230
3/690
PANORAMIC Butler (RCT)
40%
0.60 [0.14-2.51]
death
3/12,529
5/12,525 Wong (PSM)
24%
0.76 [0.61-0.95]
death Liu
-162%
2.62 [0.11-60.6]
ICU
1/26
0/16 Sinha (RCT)
65%
0.35 [0.16-0.73]
hosp.
9/608
26/610 Zheng
-100%
2.00 [1.23-3.23]
death/hosp.
61/2,689
34/3,331
OT1 Bajema (PSM)
18%
0.82 [0.52-1.29]
death
24/897
29.0/897 Inaba
58%
0.42 [0.02-10.1]
death
0/84
1/210 Evans
51%
0.49 [0.29-0.83]
death/hosp.
359 (n)
4,973 (n) Goodwin
-110%
2.10 [0.19-22.9]
death
1/80
2/336 Tazare
-9%
1.09 [0.93-1.27]
death/hosp. Butt
-9%
1.09 [0.73-1.63]
death/hosp.
48/1,459
44/1,459
Tau2 = 0.22, I2 = 80.4%, p = 0.032
Early treatment
23%
0.77 [0.60-0.98]
268/26,980
547.0/50,970
23% lower risk 033864 (RCT)
0%
1.00 [0.50-2.00]
improv.
n/a
n/a
FUTILITY, PENDING2
Improvement, RR [CI]
Treatment
Control 035424 (RCT)
0%
1.00 [0.50-2.00]
improv.
n/a
n/a
FUTILITY, PENDING2
MOVe-IN Arribas (DB RCT)
-282%
3.82 [0.50-29.1]
death
11/216
1/75 Wan
11%
0.89 [0.81-0.98]
death
704/6,153
2,541/17,283
Tau2 = 0.00, I2 = 0.0%, p = 0.0047
Late treatment
11%
0.89 [0.83-0.97]
715/6,369
2,542/17,358
11% lower risk
MOVe-AHEAD Alpizar (DB RCT)
24%
0.76 [0.57-1.01]
symp. case
78/763
103/764
Improvement, RR [CI]
Treatment
Control
Tau2 = 0.00, I2 = 0.0%, p = 0.049
Prophylaxis
24%
0.76 [0.57-1.01]
78/763
103/764
24% lower risk
All studies
20%
0.80 [0.67-0.95]
1,061/34,112
3,192.0/69,092
20% lower risk
32 molnupiravir COVID-19 studies after exclusions
c19 early
Tau2 = 0.12, I2 = 77.9%, p = 0.012
Effect extraction pre-specified
1 OT: comparison with other treatment 2 FUTILITY: terminated for futility, results pending
Favors molnupiravir
Favors control
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Fischer (RCT)
77%
0.23 [0.01-5.69]
0/140
1/62
Improvement, RR [CI]
Treatment
Control
MOVe-OUT Jayk Ber.. (DB RCT)
89%
0.11 [0.01-0.86]
1/709
9/699 Wong (PSM)
52%
0.48 [0.40-0.59]
1,856 (n)
1,856 (n) Flisiak
39%
0.61 [0.38-0.97]
20/203
63/387 Najjar-Deb.. (PSM)
19%
0.81 [0.46-1.43]
22/2,661
27/2,661 Arbel 65+
74%
0.26 [0.10-0.73]
4/845
137/12,724 Arbel 40-64
-1182%
12.82 [3.41-48.2]
4/224
7/6,075 Suzuki (PSM)
-100%
2.00 [0.34-11.9]
2/230
3/690
PANORAMIC Butler (RCT)
40%
0.60 [0.14-2.51]
3/12,529
5/12,525 Wong (PSM)
24%
0.76 [0.61-0.95] Bajema (PSM)
18%
0.82 [0.52-1.29]
24/897
29.0/897 Inaba
58%
0.42 [0.02-10.1]
0/84
1/210 Goodwin
-110%
2.10 [0.19-22.9]
1/80
2/336
Tau2 = 0.20, I2 = 72.9%, p = 0.094
Early treatment
27%
0.73 [0.51-1.06]
81/20,458
284.0/39,122
27% lower risk
MOVe-IN Arribas (DB RCT)
-282%
3.82 [0.50-29.1]
11/216
1/75
Improvement, RR [CI]
Treatment
Control Wan
11%
0.89 [0.81-0.98]
704/6,153
2,541/17,283
Tau2 = 0.52, I2 = 49.4%, p = 0.71
Late treatment
-28%
1.28 [0.37-4.38]
715/6,369
2,542/17,358
28% higher risk
All studies
23%
0.77 [0.57-1.03]
796/26,827
2,826.0/56,480
23% lower risk
15 molnupiravir COVID-19 mortality results
c19 early
Tau2 = 0.14, I2 = 79.5%, p = 0.08
Favors molnupiravir
Favors control
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Wong (PSM)
58%
0.42 [0.17-1.01]
1,856 (n)
1,856 (n)
Improvement, RR [CI]
Treatment
Control Flisiak
5%
0.95 [0.39-2.32]
7/203
14/387 Suzuki (PSM)
57%
0.43 [0.02-10.5]
0/230
1/690 Wong (PSM)
60%
0.40 [0.19-0.84] Bajema (PSM)
17%
0.83 [0.17-4.12]
3/897
3.6/897
Tau2 = 0.00, I2 = 0.0%, p = 0.0083
Early treatment
46%
0.54 [0.34-0.85]
10/3,186
18.6/3,830
46% lower risk
All studies
46%
0.54 [0.34-0.85]
10/3,186
18.6/3,830
46% lower risk
5 molnupiravir COVID-19 mechanical ventilation results
c19 early
Tau2 = 0.00, I2 = 0.0%, p = 0.0083
Favors molnupiravir
Favors control
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Wong (PSM)
26%
0.74 [0.45-1.21]
Improvement, RR [CI]
Treatment
Control Liu
-162%
2.62 [0.11-60.6]
1/26
0/16 Bajema (PSM)
1%
0.99 [0.41-2.37]
10/897
10.1/897
Tau2 = 0.00, I2 = 0.0%, p = 0.35
Early treatment
19%
0.81 [0.53-1.25]
11/923
10.1/913
19% lower risk
All studies
19%
0.81 [0.53-1.25]
11/923
10.1/913
19% lower risk
3 molnupiravir COVID-19 ICU results
c19 early
Tau2 = 0.00, I2 = 0.0%, p = 0.35
Favors molnupiravir
Favors control
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Fischer (RCT)
-33%
1.33 [0.14-12.5]
hosp.
3/140
1/62
Improvement, RR [CI]
Treatment
Control Hetero (RCT)
70%
0.30 [0.13-0.70]
hosp.
7/371
23/370 Tippabhotla (RCT)
46%
0.54 [0.22-1.34]
hosp.
7/610
13/610 Wong (PSM)
6%
0.94 [0.89-1.00]
hosp. time
1,856 (n)
1,856 (n) Yip (PSW)
-17%
1.17 [0.99-1.39]
hosp. Flisiak
-1%
1.01 [0.71-1.43]
hosp. time
203 (n)
387 (n)
AGILE CST-2 Khoo (DB RCT)
89%
0.11 [0.01-2.03]
hosp.
0/90
4/90 Arbel 65+
45%
0.55 [0.34-0.88]
hosp.
18/845
513/12,724 Arbel 40-64
-80%
1.80 [0.86-3.77]
hosp.
8/224
97/6,075 Brown
-101%
2.01 [0.43-9.38]
hosp.
8/442
2/222
PANORAMIC Butler (RCT)
-7%
1.07 [0.81-1.41]
hosp.
103/12,529
96/12,525 Wong (PSM)
2%
0.98 [0.89-1.06]
hosp. Liu
18%
0.82 [0.63-1.06]
hosp. time
26 (n)
16 (n) Sinha (RCT)
65%
0.35 [0.16-0.73]
hosp.
9/608
26/610 Bajema (PSM)
-30%
1.30 [1.01-1.68]
hosp.
162/897
124.3/897 Inaba
-127%
2.27 [0.60-7.25]
hosp.
5/84
8/210 Goodwin
58%
0.42 [0.05-3.23]
hosp.
1/80
10/336
Tau2 = 0.02, I2 = 69.9%, p = 0.6
Early treatment
3%
0.97 [0.86-1.09]
331/19,005
917.3/36,990
3% lower risk Wan
1%
0.99 [0.93-1.05]
hosp.
2,298/6,153
2,541/17,283
Improvement, RR [CI]
Treatment
Control
Tau2 = 0.00, I2 = 0.0%, p = 0.7
Late treatment
1%
0.99 [0.93-1.05]
2,298/6,153
2,541/17,283
1% lower risk
All studies
2%
0.98 [0.90-1.08]
2,629/25,158
3,458.3/54,273
2% lower risk
18 molnupiravir COVID-19 hospitalization results
c19 early
Tau2 = 0.01, I2 = 68.1%, p = 0.73
Favors molnupiravir
Favors control
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Fischer (RCT)
77%
0.23 [0.01-5.69]
death
0/140
1/62
Improvement, RR [CI]
Treatment
Control Hetero (RCT)
70%
0.30 [0.13-0.70]
hosp.
7/371
23/370
MOVe-OUT Jayk Ber.. (DB RCT)
89%
0.11 [0.01-0.86]
death
1/709
9/699 Tippabhotla (RCT)
46%
0.54 [0.22-1.34]
hosp.
7/610
13/610 Wong (PSM)
52%
0.48 [0.40-0.59]
death
1,856 (n)
1,856 (n) Yip (PSW)
-12%
1.12 [0.68-1.82]
death/ICU Flisiak
39%
0.61 [0.38-0.97]
death
20/203
63/387
AGILE CST-2 Khoo (DB RCT)
67%
0.33 [0.01-8.08]
oxygen
0/90
1/90 Kneidinger
-15%
1.15 [0.56-2.37]
severe case
8/46
26/172 Najjar-Deb.. (PSM)
19%
0.81 [0.46-1.43]
death
22/2,661
27/2,661 Arbel 65+
74%
0.26 [0.10-0.73]
death
4/845
137/12,724 Arbel 40-64
-1182%
12.82 [3.41-48.2]
death
4/224
7/6,075 Suzuki (PSM)
-100%
2.00 [0.34-11.9]
death
2/230
3/690 Brown
-101%
2.01 [0.43-9.38]
hosp.
8/442
2/222
PANORAMIC Butler (RCT)
40%
0.60 [0.14-2.51]
death
3/12,529
5/12,525 Wong (PSM)
24%
0.76 [0.61-0.95]
death Liu
-162%
2.62 [0.11-60.6]
ICU
1/26
0/16 Sinha (RCT)
65%
0.35 [0.16-0.73]
hosp.
9/608
26/610 Zheng
-100%
2.00 [1.23-3.23]
death/hosp.
61/2,689
34/3,331
OT1 Bajema (PSM)
18%
0.82 [0.52-1.29]
death
24/897
29.0/897 Inaba
58%
0.42 [0.02-10.1]
death
0/84
1/210 Zheng (PSW)
-285%
3.85 [1.54-10.0]
death/hosp.
11/802
33/4,836
OT1 Evans
51%
0.49 [0.29-0.83]
death/hosp.
359 (n)
4,973 (n) Goodwin
-110%
2.10 [0.19-22.9]
death
1/80
2/336 Tazare
-9%
1.09 [0.93-1.27]
death/hosp. Butt
-9%
1.09 [0.73-1.63]
death/hosp.
48/1,459
44/1,459
Tau2 = 0.25, I2 = 81.6%, p = 0.28
Early treatment
14%
0.86 [0.67-1.12]
241/27,960
486.0/55,811
14% lower risk
MOVe-IN Arribas (DB RCT)
-282%
3.82 [0.50-29.1]
death
11/216
1/75
Improvement, RR [CI]
Treatment
Control Wan
11%
0.89 [0.81-0.98]
death
704/6,153
2,541/17,283
Tau2 = 0.52, I2 = 49.4%, p = 0.71
Late treatment
-28%
1.28 [0.37-4.38]
715/6,369
2,542/17,358
28% higher risk
All studies
12%
0.88 [0.71-1.08]
956/34,329
3,028.0/73,169
12% lower risk
28 molnupiravir COVID-19 serious outcomes
c19 early
Tau2 = 0.14, I2 = 80.5%, p = 0.21
Effect extraction pre-specified (most serious outcome)
1 OT: comparison with other treatment
Favors molnupiravir
Favors control
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Hetero (RCT)
33%
0.67 [0.54-0.82]
recov. time
371 (n)
370 (n)
Improvement, RR [CI]
Treatment
Control Khoo (RCT)
-33%
1.33 [0.55-3.26]
no recov.
8/12
3/6
MOVe-OUT Jayk Ber.. (DB RCT)
15%
0.85 [0.75-0.98]
recovery
709 (n)
699 (n) Zou (RCT)
29%
0.71 [0.28-1.85]
recov. time
77 (n)
31 (n)
AGILE CST-2 Khoo (DB RCT)
-12%
1.12 [0.71-1.79]
no recov.
27/90
24/90
PANORAMIC Butler (RCT)
22%
0.78 [0.75-0.81]
no recov.
3,856/12,403
4,838/12,140
Tau2 = 0.00, I2 = 36.4%, p < 0.0001
Early treatment
20%
0.80 [0.72-0.88]
3,891/13,662
4,865/13,336
20% lower risk 033864 (RCT)
0%
1.00 [0.50-2.00]
improv.
n/a
n/a
FUTILITY, PENDING1
Improvement, RR [CI]
Treatment
Control 035424 (RCT)
0%
1.00 [0.50-2.00]
improv.
n/a
n/a
FUTILITY, PENDING1
MOVe-IN Arribas (DB RCT)
1%
0.99 [0.68-1.45]
no recov.
72 (n)
75 (n)
Tau2 = 0.00, I2 = 0.0%, p = 0.97
Late treatment
1%
0.99 [0.74-1.34]
0/72
0/75
1% lower risk
All studies
19%
0.81 [0.74-0.88]
3,891/13,734
4,865/13,411
19% lower risk
9 molnupiravir COVID-19 recovery results
c19 early
Tau2 = 0.00, I2 = 22.1%, p < 0.0001
1 FUTILITY: terminated for futility, results pending
Favors molnupiravir
Favors control
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+
MOVe-AHEAD Alpizar (DB RCT)
24%
0.76 [0.57-1.01]
symp. case
78/763
103/764
Improvement, RR [CI]
Treatment
Control
Tau2 = 0.00, I2 = 0.0%, p = 0.049
Prophylaxis
24%
0.76 [0.57-1.01]
78/763
103/764
24% lower risk
All studies
24%
0.76 [0.57-1.01]
78/763
103/764
24% lower risk
1 molnupiravir COVID-19 case result
c19 early
Tau2 = 0.00, I2 = 0.0%, p = 0.049
Favors molnupiravir
Favors control
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Fischer (RCT)
49%
0.51 [0.22-1.18]
viral+
10/118
9/54
Improvement, RR [CI]
Treatment
Control Optimus (RCT)
58%
0.42 [0.31-0.58]
viral+
38/175
93/180 Tippabhotla (RCT)
59%
0.41 [0.29-0.57]
viral+
42/610
103/610 Wong (PSM)
28%
0.72 [0.61-0.87]
viral+
1,856 (n)
1,856 (n) Zou (RCT)
10%
0.90 [0.83-0.97]
viral time
76 (n)
31 (n)
AGILE CST-2 Khoo (DB RCT)
23%
0.77 [0.58-1.09]
viral+
90 (n)
90 (n)
PANORAMIC Butler (RCT)
-95%
1.95 [1.15-3.31]
viral load
21 (n)
11 (n) Liu
21%
0.79 [0.59-1.05]
viral time
26 (n)
16 (n) Sinha (RCT)
48%
0.52 [0.42-0.63]
viral load
608 (n)
610 (n)
Tau2 = 0.10, I2 = 88.8%, p = 0.0017
Early treatment
32%
0.68 [0.54-0.87]
90/3,580
205/3,458
32% lower risk
MOVe-IN Arribas (DB RCT)
12%
0.88 [0.62-1.25]
viral+
26/52
34/60
Improvement, RR [CI]
Treatment
Control
Tau2 = 0.00, I2 = 0.0%, p = 0.49
Late treatment
12%
0.88 [0.62-1.25]
26/52
34/60
12% lower risk
All studies
30%
0.70 [0.56-0.87]
116/3,632
239/3,518
30% lower risk
10 molnupiravir COVID-19 viral clearance results
c19 early
Tau2 = 0.10, I2 = 87.5%, p = 0.0015
Favors molnupiravir
Favors control
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Fischer (RCT)
77%
0.23 [0.01-5.69]
death
0/140
1/62
Improvement, RR [CI]
Treatment
Control Hetero (RCT)
70%
0.30 [0.13-0.70]
hosp.
7/371
23/370 Optimus (RCT)
58%
0.42 [0.31-0.58]
viral+
38/175
93/180 Khoo (RCT)
-33%
1.33 [0.55-3.26]
no recov.
8/12
3/6
MOVe-OUT Jayk Ber.. (DB RCT)
89%
0.11 [0.01-0.86]
death
1/709
9/699 Tippabhotla (RCT)
46%
0.54 [0.22-1.34]
hosp.
7/610
13/610 Zou (RCT)
29%
0.71 [0.28-1.85]
recov. time
77 (n)
31 (n)
AGILE CST-2 Khoo (DB RCT)
67%
0.33 [0.01-8.08]
oxygen
0/90
1/90
PANORAMIC Butler (RCT)
40%
0.60 [0.14-2.51]
death
3/12,529
5/12,525 Sinha (RCT)
65%
0.35 [0.16-0.73]
hosp.
9/608
26/610
Tau2 = 0.03, I2 = 13.1%, p < 0.0001
Early treatment
54%
0.46 [0.35-0.63]
73/15,321
174/15,183
54% lower risk 033864 (RCT)
0%
1.00 [0.50-2.00]
improv.
n/a
n/a
FUTILITY, PENDING1
Improvement, RR [CI]
Treatment
Control 035424 (RCT)
0%
1.00 [0.50-2.00]
improv.
n/a
n/a
FUTILITY, PENDING1
MOVe-IN Arribas (DB RCT)
-282%
3.82 [0.50-29.1]
death
11/216
1/75
Tau2 = 0.00, I2 = 0.0%, p = 0.77
Late treatment
-8%
1.08 [0.67-1.73]
11/216
1/75
8% higher risk
MOVe-AHEAD Alpizar (DB RCT)
24%
0.76 [0.57-1.01]
symp. case
78/763
103/764
Improvement, RR [CI]
Treatment
Control
Tau2 = 0.00, I2 = 0.0%, p = 0.049
Prophylaxis
24%
0.76 [0.57-1.01]
78/763
103/764
24% lower risk
All studies
38%
0.62 [0.46-0.84]
162/16,300
278/16,022
38% lower risk
14 molnupiravir COVID-19 Randomized Controlled Trials
c19 early
Tau2 = 0.12, I2 = 49.8%, p = 0.0021
Effect extraction pre-specified
1 FUTILITY: terminated for futility, results pending
Favors molnupiravir
Favors control
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Fischer (RCT)
77%
0.23 [0.01-5.69]
0/140
1/62
Improvement, RR [CI]
Treatment
Control
MOVe-OUT Jayk Ber.. (DB RCT)
89%
0.11 [0.01-0.86]
1/709
9/699
PANORAMIC Butler (RCT)
40%
0.60 [0.14-2.51]
3/12,529
5/12,525
Tau2 = 0.00, I2 = 0.0%, p = 0.048
Early treatment
67%
0.33 [0.11-0.99]
4/13,378
15/13,286
67% lower risk
MOVe-IN Arribas (DB RCT)
-282%
3.82 [0.50-29.1]
11/216
1/75
Improvement, RR [CI]
Treatment
Control
Tau2 = 0.00, I2 = 0.0%, p = 0.2
Late treatment
-282%
3.82 [0.50-29.1]
11/216
1/75
282% higher risk
All studies
45%
0.55 [0.13-2.38]
15/13,594
16/13,361
45% lower risk
4 molnupiravir COVID-19 RCT mortality results
c19 early
Tau2 = 1.13, I2 = 51.1%, p = 0.43
Favors molnupiravir
Favors control
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Hetero (RCT)
70%
0.30 [0.13-0.70]
hosp.
7/371
23/370
Improvement, RR [CI]
Treatment
Control Khoo (RCT)
-33%
1.33 [0.55-3.26]
no recov.
8/12
3/6
MOVe-OUT Jayk Ber.. (DB RCT)
89%
0.11 [0.01-0.86]
death
1/709
9/699 Tippabhotla (RCT)
46%
0.54 [0.22-1.34]
hosp.
7/610
13/610 Wong (PSM)
52%
0.48 [0.40-0.59]
death
1,856 (n)
1,856 (n) Yip (PSW)
-12%
1.12 [0.68-1.82]
death/ICU Zou (RCT)
29%
0.71 [0.28-1.85]
recov. time
77 (n)
31 (n) Flisiak
39%
0.61 [0.38-0.97]
death
20/203
63/387
AGILE CST-2 Khoo (DB RCT)
67%
0.33 [0.01-8.08]
oxygen
0/90
1/90 Kneidinger
-15%
1.15 [0.56-2.37]
severe case
8/46
26/172 Najjar-Deb.. (PSM)
19%
0.81 [0.46-1.43]
death
22/2,661
27/2,661 Suzuki (PSM)
-100%
2.00 [0.34-11.9]
death
2/230
3/690 Brown
-101%
2.01 [0.43-9.38]
hosp.
8/442
2/222
PANORAMIC Butler (RCT)
40%
0.60 [0.14-2.51]
death
3/12,529
5/12,525 Wong (PSM)
24%
0.76 [0.61-0.95]
death Liu
-162%
2.62 [0.11-60.6]
ICU
1/26
0/16 Sinha (RCT)
65%
0.35 [0.16-0.73]
hosp.
9/608
26/610 Zheng
-100%
2.00 [1.23-3.23]
death/hosp.
61/2,689
34/3,331
OT1 Evans
51%
0.49 [0.29-0.83]
death/hosp.
359 (n)
4,973 (n) Goodwin
-110%
2.10 [0.19-22.9]
death
1/80
2/336 Butt
-9%
1.09 [0.73-1.63]
death/hosp.
48/1,459
44/1,459
Tau2 = 0.18, I2 = 73.0%, p = 0.048
Early treatment
23%
0.77 [0.60-1.00]
206/25,057
281/31,044
23% lower risk
MOVe-IN Arribas (DB RCT)
-282%
3.82 [0.50-29.1]
death
11/216
1/75
Improvement, RR [CI]
Treatment
Control Wan
11%
0.89 [0.81-0.98]
death
704/6,153
2,541/17,283
Tau2 = 0.52, I2 = 49.4%, p = 0.71
Late treatment
-28%
1.28 [0.37-4.38]
715/6,369
2,542/17,358
28% higher risk
MOVe-AHEAD Alpizar (DB RCT)
24%
0.76 [0.57-1.01]
symp. case
78/763
103/764
Improvement, RR [CI]
Treatment
Control
Tau2 = 0.00, I2 = 0.0%, p = 0.049
Prophylaxis
24%
0.76 [0.57-1.01]
78/763
103/764
24% lower risk
All studies
21%
0.79 [0.65-0.96]
999/32,189
2,926/49,166
21% lower risk
24 molnupiravir COVID-19 peer reviewed studies
c19 early
Tau2 = 0.10, I2 = 73.2%, p = 0.018
Effect extraction pre-specified (most serious outcome)
1 OT: comparison with other treatment
Favors molnupiravir
Favors control
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Fischer (RCT)
77%
0.23 [0.01-5.69]
death
0/140
1/62
Improvement, RR [CI]
Treatment
Control Fischer (RCT)
65%
0.35 [0.01-8.33]
death
0/55
1/62 Fischer (RCT)
67%
0.33 [0.01-8.03]
death
0/62
1/62 Fischer (RCT)
58%
0.42 [0.02-10.0]
death
0/23
1/62 Fischer (RCT)
-33%
1.33 [0.14-12.5]
hosp.
3/140
1/62 Fischer (RCT)
-13%
1.13 [0.07-17.6]
hosp.
1/55
1/62 Fischer (RCT)
-100%
2.00 [0.19-21.5]
hosp.
2/62
1/62 Fischer (RCT)
58%
0.42 [0.02-10.0]
hosp.
0/23
1/62 Fischer (RCT)
49%
0.51 [0.22-1.18]
viral+
10/118
9/54 Fischer (RCT)
89%
0.11 [0.01-0.86]
viral+
1/53
9/54 Fischer (RCT)
30%
0.70 [0.25-1.93]
viral+
5/43
9/54 Fischer (RCT)
-9%
1.09 [0.37-3.18]
viral+
4/22
9/54 Fischer (RCT)
92%
0.08 [0.01-0.62]
viral+
1/117
6/54 Fischer (RCT)
92%
0.08 [0.01-0.75]
viral+
0/53
6/54 Fischer (RCT)
91%
0.09 [0.01-0.83]
viral+
0/42
6/54 Fischer (RCT)
59%
0.41 [0.05-3.20]
viral+
1/22
6/54 Fischer (RCT)
30%
0.70 [0.37-1.36]
viral+
19/137
12/61 Fischer (RCT)
62%
0.38 [0.13-1.12]
viral+
4/53
12/61 Fischer (RCT)
-8%
1.08 [0.54-2.18]
viral+
13/61
12/61 Fischer (RCT)
56%
0.44 [0.11-1.83]
viral+
2/23
12/61 Hetero (RCT)
70%
0.30 [0.13-0.70]
hosp.
7/371
23/370 Hetero (RCT)
33%
0.67 [0.54-0.82]
recov. time
371 (n)
370 (n) Optimus (RCT)
58%
0.42 [0.31-0.58]
viral+
38/175
93/180 Khoo (RCT)
-33%
1.33 [0.55-3.26]
no recov.
8/12
3/6 Khoo (RCT)
-100%
2.00 [0.28-14.2]
no recov.
4/12
1/6 Khoo (RCT)
-100%
2.00 [0.90-4.43]
no recov.
4/4
3/6 Khoo (RCT)
0%
1.00 [0.28-3.54]
no recov.
2/4
3/6 Khoo (RCT)
0%
1.00 [0.28-3.54]
no recov.
2/4
3/6 Khoo (RCT)
-50%
1.50 [0.13-17.7]
no recov.
1/4
1/6 Khoo (RCT)
-200%
3.00 [0.39-23.1]
no recov.
2/4
1/6 Khoo (RCT)
-50%
1.50 [0.13-17.7]
no recov.
1/4
1/6
MOVe-OUT Jayk Ber.. (DB RCT)
89%
0.11 [0.01-0.86]
death
1/709
9/699
MOVe-OUT Jayk Ber.. (DB RCT)
30%
0.70 [0.48-1.00]
death/hosp.
48/709
68/699
MOVe-OUT Jayk Ber.. (DB RCT)
94%
0.06 [0.00-0.97]
death/hosp.
0/37
9/47
MOVe-OUT Jayk Ber.. (DB RCT)
50%
0.50 [0.20-1.26]
death/hosp.
6/75
13/82
MOVe-OUT Jayk Ber.. (DB RCT)
24%
0.76 [0.42-1.38]
death/hosp.
18/237
22/221
MOVe-OUT Jayk Ber.. (DB RCT)
42%
0.58 [0.20-1.68]
death/hosp.
5/47
7/38
MOVe-OUT Jayk Ber.. (DB RCT)
15%
0.85 [0.75-0.98]
recovery
709 (n)
699 (n)
MOVe-OUT Jayk Ber.. (DB RCT)
19%
0.81 [0.71-0.92]
recovery
709 (n)
699 (n)
MOVe-OUT Jayk Ber.. (DB RCT)
15%
0.85 [0.75-0.97]
recovery
709 (n)
699 (n)
MOVe-OUT Jayk Ber.. (DB RCT)
14%
0.86 [0.76-0.97]
recovery
709 (n)
699 (n) Tippabhotla (RCT)
46%
0.54 [0.22-1.34]
hosp.
7/610
13/610 Tippabhotla (RCT)
46%
0.54 [0.41-0.71]
no improv.
67/610
125/610 Tippabhotla (RCT)
52%
0.48 [0.42-0.54]
no improv.
199/610
417/610 Tippabhotla (RCT)
25%
0.75 [0.71-0.79]
no improv.
433/610
576/610 Tippabhotla (RCT)
59%
0.41 [0.29-0.57]
viral+
42/610
103/610 Tippabhotla (RCT)
81%
0.19 [0.15-0.24]
viral+
62/610
327/610 Tippabhotla (RCT)
78%
0.22 [0.19-0.27]
viral+
113/610
505/610 Wong (PSM)
52%
0.48 [0.40-0.59]
death
1,856 (n)
1,856 (n) Wong (PSM)
58%
0.42 [0.17-1.01]
ventilation
1,856 (n)
1,856 (n) Wong (PSM)
40%
0.60 [0.52-0.69]
progression
1,856 (n)
1,856 (n) Wong (PSM)
6%
0.94 [0.89-1.00]
hosp. time
1,856 (n)
1,856 (n) Wong (PSM)
28%
0.72 [0.61-0.87]
viral+
1,856 (n)
1,856 (n) Yip (PSW)
-12%
1.12 [0.68-1.82]
death/ICU Yip (PSW)
-17%
1.17 [0.99-1.39]
hosp. Zou (RCT)
29%
0.71 [0.28-1.85]
recov. time
77 (n)
31 (n) Zou (RCT)
10%
0.90 [0.83-0.97]
viral time
76 (n)
31 (n) Zou (RCT)
51%
0.49 [0.28-0.84]
viral+
18/76
15/31 Zou (RCT)
37%
0.63 [0.51-0.78]
viral+
45/76
29/31 Zou (RCT)
18%
0.82 [0.73-0.92]
viral+
62/76
31/31 Flisiak
39%
0.61 [0.38-0.97]
death
20/203
63/387 Flisiak
5%
0.95 [0.39-2.32]
ventilation
7/203
14/387 Flisiak
-1%
1.01 [0.71-1.43]
hosp. time
203 (n)
387 (n)
AGILE CST-2 Khoo (DB RCT)
67%
0.33 [0.01-8.08]
oxygen
0/90
1/90
AGILE CST-2 Khoo (DB RCT)
89%
0.11 [0.01-2.03]
hosp.
0/90
4/90
AGILE CST-2 Khoo (DB RCT)
-12%
1.12 [0.71-1.79]
no recov.
27/90
24/90
AGILE CST-2 Khoo (DB RCT)
23%
0.77 [0.58-1.09]
viral+
90 (n)
90 (n) Kneidinger
-15%
1.15 [0.56-2.37]
severe case
8/46
26/172 Najjar-Deb.. (PSM)
19%
0.81 [0.46-1.43]
death
22/2,661
27/2,661 Najjar-Deb.. (PSM)
17%
0.83 [0.57-1.21]
progression
50/2,661
60/2,661 Najjar-Deb.. (PSM)
25%
0.75 [0.51-1.12]
severe case
43/2,661
57/2,661 Arbel 65+
74%
0.26 [0.10-0.73]
death
4/845
137/12,724 Arbel 65+
-1182%
12.82 [3.41-48.2]
death
4/224
7/6,075 Arbel 65+
45%
0.55 [0.34-0.88]
hosp.
18/845
513/12,724 Arbel 65+
-80%
1.80 [0.86-3.77]
hosp.
8/224
97/6,075 Arbel 40-64
-1182%
12.82 [3.41-48.2]
death
4/224
7/6,075 Arbel 40-64
-80%
1.80 [0.86-3.77]
hosp.
8/224
97/6,075 Suzuki (PSM)
-100%
2.00 [0.34-11.9]
death
2/230
3/690 Suzuki (PSM)
57%
0.43 [0.02-10.5]
ventilation
0/230
1/690 Suzuki (PSM)
53%
0.47 [0.22-0.98]
progression
9/230
58/690 Brown
-101%
2.01 [0.43-9.38]
hosp.
8/442
2/222
PANORAMIC Butler (RCT)
40%
0.60 [0.14-2.51]
death
3/12,529
5/12,525
PANORAMIC Butler (RCT)
-6%
1.06 [0.81-1.41]
death/hosp.
105/12,529
98/12,525
PANORAMIC Butler (RCT)
-7%
1.07 [0.81-1.41]
hosp.
103/12,529
96/12,525
PANORAMIC Butler (RCT)
2%
0.98 [0.94-1.01]
transmission
3,887/10,803
3,873/10,548
PANORAMIC Butler (RCT)
22%
0.78 [0.75-0.81]
no recov.
3,856/12,403
4,838/12,140
PANORAMIC Butler (RCT)
19%
0.81 [0.78-0.83]
recov. time
12,403 (n)
12,140 (n)
PANORAMIC Butler (RCT)
30%
0.70 [0.67-0.73]
no recov.
2,675/12,403
3,766/12,140
PANORAMIC Butler (RCT)
26%
0.74 [0.71-0.76]
recov. time
12,403 (n)
12,140 (n)
PANORAMIC Butler (RCT)
-95%
1.95 [1.15-3.31]
viral load
21 (n)
11 (n)
PANORAMIC Butler (RCT)
92%
0.08 [0.05-0.14]
viral load
33 (n)
26 (n) Wong (PSM)
24%
0.76 [0.61-0.95]
death Wong (PSM)
60%
0.40 [0.19-0.84]
ventilation Wong (PSM)
26%
0.74 [0.45-1.21]
ICU Wong (PSM)
2%
0.98 [0.89-1.06]
hosp. Liu
-162%
2.62 [0.11-60.6]
ICU
1/26
0/16 Liu
8%
0.92 [0.17-4.94]
progression
3/26
2/16 Liu
18%
0.82 [0.63-1.06]
hosp. time
26 (n)
16 (n) Liu
21%
0.79 [0.59-1.05]
viral time
26 (n)
16 (n) Liu
-23%
1.23 [0.12-12.5]
viral+
2/26
1/16 Liu
28%
0.72 [0.29-1.76]
viral+
7/26
6/16 Liu
38%
0.62 [0.41-0.92]
viral+
14/26
14/16 Liu
18%
0.82 [0.64-1.05]
viral+
20/26
15/16 Liu
12%
0.88 [0.75-1.05]
viral+
23/26
16/16 Sinha (RCT)
65%
0.35 [0.16-0.73]
hosp.
9/608
26/610 Sinha (RCT)
53%
0.47 [0.26-0.85]
no improv.
16/608
34/610 Sinha (RCT)
48%
0.52 [0.42-0.63]
viral load
608 (n)
610 (n) Zheng
-100%
2.00 [1.23-3.23]
death/hosp.
61/2,689
34/3,331
OT1 Zheng
-85%
1.85 [1.14-3.03]
death/hosp.
55/2,689
32/3,331
OT1 Bajema (PSM)
18%
0.82 [0.52-1.29]
death
24/897
29.0/897 Bajema (PSM)
49%
0.51 [0.20-1.27]
death
7/897
13.8/897 Bajema (PSM)
17%
0.83 [0.17-4.12]
ventilation
3/897
3.6/897 Bajema (PSM)
1%
0.99 [0.41-2.37]
ICU
10/897
10.1/897 Bajema (PSM)
-30%
1.30 [1.01-1.68]
hosp.
162/897
124.3/897 Bajema (PSM)
9%
0.91 [0.59-1.41]
hosp.
37/897
40.5/897 Inaba
58%
0.42 [0.02-10.1]
death
0/84
1/210 Inaba
-127%
2.27 [0.60-7.25]
death/hosp.
5/84
8/210 Inaba
-127%
2.27 [0.60-7.25]
hosp.
5/84
8/210 Zheng (PSW)
-285%
3.85 [1.54-10.0]
death/hosp.
11/802
33/4,836
OT1 Evans
51%
0.49 [0.29-0.83]
death/hosp.
359 (n)
4,973 (n) Goodwin
-110%
2.10 [0.19-22.9]
death
1/80
2/336 Goodwin
58%
0.42 [0.05-3.23]
hosp.
1/80
10/336 Goodwin
53%
0.47 [0.11-1.97]
hosp.
2/80
18/336 Tazare
-9%
1.09 [0.93-1.27]
death/hosp. Butt
-9%
1.09 [0.73-1.63]
death/hosp.
48/1,459
44/1,459 033864 (RCT)
0%
1.00 [0.50-2.00]
improv.
n/a
n/a
FUTILITY, PENDING2 035424 (RCT)
0%
1.00 [0.50-2.00]
improv.
n/a
n/a
FUTILITY, PENDING2
MOVe-IN Arribas (DB RCT)
-282%
3.82 [0.50-29.1]
death
11/216
1/75
MOVe-IN Arribas (DB RCT)
-217%
3.17 [0.34-29.8]
death
3/71
1/75
MOVe-IN Arribas (DB RCT)
-317%
4.17 [0.48-36.4]
death
4/72
1/75
MOVe-IN Arribas (DB RCT)
-311%
4.11 [0.47-35.9]
death
4/73
1/75
MOVe-IN Arribas (DB RCT)
1%
0.99 [0.68-1.45]
no recov.
72 (n)
75 (n)
MOVe-IN Arribas (DB RCT)
12%
0.88 [0.61-1.28]
no recov.
73 (n)
75 (n)
MOVe-IN Arribas (DB RCT)
-1%
1.01 [0.69-1.47]
no recov.
73 (n)
75 (n)
MOVe-IN Arribas (DB RCT)
12%
0.88 [0.62-1.25]
viral+
26/52
34/60
MOVe-IN Arribas (DB RCT)
-2%
1.02 [0.74-1.41]
viral+
29/50
34/60
MOVe-IN Arribas (DB RCT)
21%
0.79 [0.56-1.13]
viral+
27/60
34/60
MOVe-IN Arribas (DB RCT)
8%
0.92 [0.41-2.08]
viral+
9/53
10/54
MOVe-IN Arribas (DB RCT)
-48%
1.48 [0.72-3.03]
viral+
14/51
10/54
MOVe-IN Arribas (DB RCT)
21%
0.79 [0.34-1.84]
viral+
8/55
10/54 Wan
11%
0.89 [0.81-0.98]
death
704/6,153
2,541/17,283 Wan
1%
0.99 [0.93-1.05]
hosp.
2,298/6,153
2,541/17,283 Wan
-4%
1.04 [0.98-1.10]
progression
2,300/6,153
2,541/17,283
MOVe-AHEAD Alpizar (DB RCT)
24%
0.76 [0.57-1.01]
symp. case
78/763
103/764
Molnupiravir COVID-19 outcomes
c19 early
1 OT: comparison with other treatment 2 FUTILITY: terminated for futility, results pending
Favors molnupiravir
Favors control
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be used based on risk/benefit analysis. No treatment, vaccine, or intervention
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