Effectiveness and safety of molnupiravir among patients with mild to moderate COVID-19: a prospective, observational, cohort study
et al., Scientific Reports, doi:10.1038/s41598-026-44971-x, NCT06223932, Apr 2026
PSM prospective observational cohort study of 844 mild COVID-19 patients (402 molnupiravir, 442 no antiviral) in Turkey showing higher progression to hospitalization, death, or new oxygen requirement within 28 days, without statistical significance in the matched cohort. For the primary outcome in the matched cohort, authors report only that statistical significance was not reached and the log-rank p value, without reporting the actual result. However, authors provided the data for the matched cohort which allows us to compute the Cox result (while not statistically significant the results contribute to meta-analysis).
Viral load was lower with treatment at day 3, without statistical significance, but higher at days 10 and 14, suggesting possible viral rebound, delayed/blunted immune response in the treatment group, or increased survival/replication of molnupiravir-mutated variants.
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.
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death, hosp., new oxygen, 200.0% higher, HR 3.00, p = 0.34, treatment 3 of 204 (1.5%), control 1 of 204 (0.5%), mortality, hospitalization, or new oxygen, propensity score matching, Cox proportional hazards.
|
|
viral load, 41.0% higher, relative load 1.41, p = 0.32, treatment 48, control 24, relative viral load, day 14.
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viral load, 192.0% higher, relative load 2.92, p = 0.07, treatment 48, control 24, relative viral load, day 10.
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viral load, 10.0% higher, relative load 1.10, p = 0.92, treatment 48, control 24, relative viral load, day 5.
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viral load, 46.0% lower, relative load 0.54, p = 0.53, treatment 48, control 24, relative viral load, day 3.
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viral load, 13.0% lower, relative load 0.87, p = 0.90, treatment 48, control 24, relative viral load, day 1.
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| Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates |
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Şimşek-Yavuz et al., 16 Apr 2026, prospective, Turkey, peer-reviewed, mean age 66.0, 36 authors, trial NCT06223932 (history).
Contact: serapsimsekyavuz@gmail.com.
Abstract: ## Scientific Reports
Article in Press
Effectiveness and safety of molnupiravir among patients with mild to moderate COVID-19: a prospective, observational, cohort study
Received: 4 November 2025
Accepted: 16 March 2026
Cite this article as: Şimşek-Yavuz S., Azap A., Öztürk-Emiral G. et al. Effectiveness and safety of molnupiravir among patients with mild to moderate COVID-19: a prospective, observational, cohort study. Sci Rep (2026). https://doi. org/10.1038/s41598-026-44971-x
ARTICLE IN PRESS Serap Şimşek-Yavuz, Alpay Azap, Gülsüm Öztürk-Emiral, Hüsna Çevik, Rahmet İnanç-Balkan, Sezen Fansa, Fatma Zehra Güneşer, Mahir Kapmaz, Nilsun Altunal, Elif Selcen Beng, Özlem Aydın, Sezen Özge Özen, Seniha Başaran, Hasan Yağmur, Meryem Çalışkan, Melek-Nur Aslan, Neslihan Uyar, Burcu Atasoy Bozan, Mihriban Aksoy, Mehtap Aydın, Duygu Korkut Akyürek, Elif Mukime Sarıcaoğlu, Önder Ergönül, Sevim Meşe, Füsun Can, Mert Ahmet Kuşkucu, Ali Ağaçfidan, Filiz Pehlivanoğlu, Özlem Altuntaş-Aydın & Alper Gündüz We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply. If this paper is publishing under a Transparent Peer Review model then Peer Review reports will publish with the final article.
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Effectiveness and safety of molnupiravir among patients with mild to moderate COVID19: A prospective, observational, cohort study
- Serap Şimşek-Yavuz 1 , Alpay Azap 2 , Gülsüm Öztürk-Emiral 3 , Hüsna Çevik 4 , Rahmet Güner 5 , Müge Ayhan 5 , Belgin Coşkun 6 , Aysun Benli 1 , Yeşim Tok 7 , Mustafa Önel 8 , İlker İnanç-Balkan 9 , Sezen Fansa 9 , Fatma Zehra Güneşer 10 , Mahir Kapmaz 11 , Nilsun Altunal 12 , Elif Selcen Beng 13 , Özlem Aydın 14 , Sezen Özge Özen 1 , Seniha Başaran 1 , Hasan Yağmur 15 , Meryem Çalışkan 15 , MelekNur Aslan 16 , Neslihan Uyar 17 , Burcu Atasoy Bozan 18 , Mihriban Aksoy 19 , Mehtap Aydın 12 , Duygu Korkut Akyürek 1 , Elif Mukime Sarıcaoğlu 2 , Önder Ergönül 11 , Sevim Meşe 7 , Füsun Can 20 , Mert Ahmet Kuşkucu 20 , Ali Ağaçfidan 8 , Filiz Pehlivanoğlu 18 , Özlem Altuntaş-Aydın 21 , Alper Gündüz 21 . 1 Istanbul University, Istanbul Faculty of Medicine, Infectious Disease and Clinical Microbiology Department, Istanbul, Türkiye 2 Ankara University, Faculty of Medicine, Infectious Disease and Clinical..
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