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Outcomes in COVID-19 molnupiravir studies
Outcomes in molnupiravir studies. Potential risks of the mechanism of action include the creation of dangerous variants, and mutagenicity, carcinogenicity, teratogenicity, and embryotoxicity [Hadj Hassine, Swanstrom, Waters]. See [twitter.com] for analysis of a variant potentially created by molnupiravir. There is substantial publication bias. Two trials (CTRI/2021/05/033864 and CTRI/2021/08/0354242) reported no significant efficacy, however the results have not been published. Multiple trials have not reported results and did not respond to requests [Lawrence].
0 0.5 1 1.5+ All studies 16% 28 81,101 Improvement, Studies, Patients Relative Risk Mortality 25% 13 59,455 Ventilation 46% 5 7,016 ICU admission 19% 3 1,836 Hospitalization 3% 16 55,579 Progression 37% 4 9,996 Recovery 19% 7 25,629 Viral clearance 32% 9 7,043 RCTs 41% 12 30,687 RCT mortality 45% 4 26,955 Peer-reviewed 21% 18 47,618 Early 19% 25 80,810 Late -8% 3 291 Molnupiravir for COVID-19 c19early.org/m Jan 2023 Favorsmolnupiravir Favorscontrol 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 Jayk Bernal (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 OT​1 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 OT​1 Evans 51% 0.49 [0.29-0.83] death/hosp. 359 (n) 4,973 (n) Tau​2 = 0.31, I​2 = 81.5%, p = 0.15 Early treatment 19% 0.81 [0.60-1.08] 238/26,608 536.0/54,202 19% improvement 033864 (RCT) 0% 1.00 [0.50-2.00] improv. n/a n/a FUTILITY, PENDING​2 Improvement, RR [CI] Treatment Control 035424 (RCT) 0% 1.00 [0.50-2.00] improv. n/a n/a FUTILITY, PENDING​2 Arribas (DB RCT) -282% 3.82 [0.50-29.1] death 11/216 1/75 Tau​2 = 0.00, I​2 = 0.0%, p = 0.77 Late treatment -8% 1.08 [0.67-1.73] 11/216 1/75 -8% improvement All studies 16% 0.84 [0.64-1.10] 249/26,824 537.0/54,277 16% improvement 28 molnupiravir COVID-19 studies c19early.org/m Jan 2023 Tau​2 = 0.30, I​2 = 79.9%, p = 0.21 Effect extraction pre-specified 1 OT: comparison with other treatment2 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 Jayk Bernal (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 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 OT​1 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) Tau​2 = 0.25, I​2 = 78.7%, p = 0.022 Early treatment 28% 0.72 [0.55-0.95] 219/25,364 501.0/49,144 28% improvement 033864 (RCT) 0% 1.00 [0.50-2.00] improv. n/a n/a FUTILITY, PENDING​2 Improvement, RR [CI] Treatment Control 035424 (RCT) 0% 1.00 [0.50-2.00] improv. n/a n/a FUTILITY, PENDING​2 Arribas (DB RCT) -282% 3.82 [0.50-29.1] death 11/216 1/75 Tau​2 = 0.00, I​2 = 0.0%, p = 0.77 Late treatment -8% 1.08 [0.67-1.73] 11/216 1/75 -8% improvement All studies 24% 0.76 [0.59-0.99] 230/25,580 502.0/49,219 24% improvement 26 molnupiravir COVID-19 studies after exclusions c19early.org/m Jan 2023 Tau​2 = 0.24, I​2 = 77.0%, p = 0.04 Effect extraction pre-specified 1 OT: comparison with other treatment2 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 Jayk Bernal (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 Tau​2 = 0.20, I​2 = 74.6%, p = 0.077 Early treatment 28% 0.72 [0.50-1.04] 80/20,378 282.0/38,786 28% improvement Arribas (DB RCT) -282% 3.82 [0.50-29.1] 11/216 1/75 Improvement, RR [CI] Treatment Control Tau​2 = 0.00, I​2 = 0.0%, p = 0.2 Late treatment -282% 3.82 [0.50-29.1] 11/216 1/75 -282% improvement All studies 25% 0.75 [0.52-1.09] 91/20,594 283.0/38,861 25% improvement 13 molnupiravir COVID-19 mortality results c19early.org/m Jan 2023 Tau​2 = 0.21, I​2 = 74.2%, p = 0.13 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 Tau​2 = 0.00, I​2 = 0.0%, p = 0.0083 Early treatment 46% 0.54 [0.34-0.85] 10/3,186 18.6/3,830 46% improvement All studies 46% 0.54 [0.34-0.85] 10/3,186 18.6/3,830 46% improvement 5 molnupiravir COVID-19 mechanical ventilation results c19early.org/m Jan 2023 Tau​2 = 0.00, I​2 = 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 Tau​2 = 0.00, I​2 = 0.0%, p = 0.35 Early treatment 19% 0.81 [0.53-1.25] 11/923 10.1/913 19% improvement All studies 19% 0.81 [0.53-1.25] 11/923 10.1/913 19% improvement 3 molnupiravir COVID-19 ICU results c19early.org/m Jan 2023 Tau​2 = 0.00, I​2 = 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 Tau​2 = 0.02, I​2 = 71.5%, p = 0.63 Early treatment 3% 0.97 [0.86-1.09] 330/18,925 907.3/36,654 3% improvement All studies 3% 0.97 [0.86-1.09] 330/18,925 907.3/36,654 3% improvement 16 molnupiravir COVID-19 hospitalization results c19early.org/m Jan 2023 Tau​2 = 0.02, I​2 = 71.5%, p = 0.63 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 Jayk Bernal (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 OT​1 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 OT​1 Evans 51% 0.49 [0.29-0.83] death/hosp. 359 (n) 4,973 (n) Tau​2 = 0.33, I​2 = 81.2%, p = 0.23 Early treatment 17% 0.83 [0.61-1.13] 192/26,421 440.0/54,016 17% improvement Arribas (DB RCT) -282% 3.82 [0.50-29.1] death 11/216 1/75 Improvement, RR [CI] Treatment Control Tau​2 = 0.00, I​2 = 0.0%, p = 0.2 Late treatment -282% 3.82 [0.50-29.1] 11/216 1/75 -282% improvement All studies 15% 0.85 [0.62-1.15] 203/26,637 441.0/54,091 15% improvement 24 molnupiravir COVID-19 serious outcomes c19early.org/m Jan 2023 Tau​2 = 0.33, I​2 = 80.7%, p = 0.3 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 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 Tau​2 = 0.01, I​2 = 50.4%, p = 0.0059 Early treatment 21% 0.79 [0.66-0.93] 3,891/12,876 4,865/12,606 21% improvement 033864 (RCT) 0% 1.00 [0.50-2.00] improv. n/a n/a FUTILITY, PENDING​1 Improvement, RR [CI] Treatment Control 035424 (RCT) 0% 1.00 [0.50-2.00] improv. n/a n/a FUTILITY, PENDING​1 Arribas (DB RCT) 1% 0.99 [0.68-1.45] no recov. 72 (n) 75 (n) Tau​2 = 0.00, I​2 = 0.0%, p = 0.97 Late treatment 1% 0.99 [0.74-1.34] 0/72 0/75 1% improvement All studies 19% 0.81 [0.71-0.92] 3,891/12,948 4,865/12,681 19% improvement 7 molnupiravir COVID-19 recovery results c19early.org/m Jan 2023 Tau​2 = 0.01, I​2 = 30.0%, p = 0.0017 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) 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) 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) Tau​2 = 0.10, I​2 = 82.8%, p = 0.0012 Early treatment 35% 0.65 [0.51-0.84] 90/3,504 205/3,427 35% improvement Arribas (DB RCT) 12% 0.88 [0.62-1.25] viral+ 26/52 34/60 Improvement, RR [CI] Treatment Control Tau​2 = 0.00, I​2 = 0.0%, p = 0.49 Late treatment 12% 0.88 [0.62-1.25] 26/52 34/60 12% improvement All studies 32% 0.68 [0.53-0.86] 116/3,556 239/3,487 32% improvement 9 molnupiravir COVID-19 viral clearance results c19early.org/m Jan 2023 Tau​2 = 0.10, I​2 = 81.8%, p = 0.0013 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 Jayk Bernal (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 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 Tau​2 = 0.04, I​2 = 15.0%, p < 0.0001 Early treatment 55% 0.45 [0.32-0.62] 73/15,244 174/15,152 55% improvement 033864 (RCT) 0% 1.00 [0.50-2.00] improv. n/a n/a FUTILITY, PENDING​1 Improvement, RR [CI] Treatment Control 035424 (RCT) 0% 1.00 [0.50-2.00] improv. n/a n/a FUTILITY, PENDING​1 Arribas (DB RCT) -282% 3.82 [0.50-29.1] death 11/216 1/75 Tau​2 = 0.00, I​2 = 0.0%, p = 0.77 Late treatment -8% 1.08 [0.67-1.73] 11/216 1/75 -8% improvement All studies 41% 0.59 [0.40-0.86] 84/15,460 175/15,227 41% improvement 12 molnupiravir COVID-19 Randomized Controlled Trials c19early.org/m Jan 2023 Tau​2 = 0.18, I​2 = 49.5%, p = 0.0069 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 Jayk Bernal (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 Tau​2 = 0.00, I​2 = 0.0%, p = 0.048 Early treatment 67% 0.33 [0.11-0.99] 4/13,378 15/13,286 67% improvement Arribas (DB RCT) -282% 3.82 [0.50-29.1] 11/216 1/75 Improvement, RR [CI] Treatment Control Tau​2 = 0.00, I​2 = 0.0%, p = 0.2 Late treatment -282% 3.82 [0.50-29.1] 11/216 1/75 -282% improvement All studies 45% 0.55 [0.13-2.38] 15/13,594 16/13,361 45% improvement 4 molnupiravir COVID-19 RCT mortality results c19early.org/m Jan 2023 Tau​2 = 1.13, I​2 = 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 Jayk Bernal (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 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 OT​1 Tau​2 = 0.21, I​2 = 76.2%, p = 0.083 Early treatment 23% 0.77 [0.57-1.04] 157/23,082 235/24,245 23% improvement Arribas (DB RCT) -282% 3.82 [0.50-29.1] death 11/216 1/75 Improvement, RR [CI] Treatment Control Tau​2 = 0.00, I​2 = 0.0%, p = 0.2 Late treatment -282% 3.82 [0.50-29.1] 11/216 1/75 -282% improvement All studies 21% 0.79 [0.58-1.07] 168/23,298 236/24,320 21% improvement 18 molnupiravir COVID-19 peer reviewed studies c19early.org/m Jan 2023 Tau​2 = 0.21, I​2 = 75.6%, p = 0.12 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+