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0 0.5 1 1.5 2+ Hospitalization 65% Improvement Relative Risk Clinical improvement 53% Improvement in Ct value 48% Sinha et al. CTRI/2021/05/033739 Molnupiravir RCT EARLY Is early treatment with molnupiravir beneficial for COVID-19? RCT 1,218 patients in India (May - August 2021) Lower hospitalization (p=0.0053) and greater improvement (p=0.013) Sinha et al., Cureus, doi:10.7759/cureus.31508 Favors molnupiravir Favors control
Efficacy and Safety of Molnupiravir in Mild COVID-19 Patients in India
Sinha et al., Efficacy and Safety of Molnupiravir in Mild COVID-19 Patients in India, Cureus, doi:10.7759/cureus.31508, CTRI/2021/05/033739
Nov 2022   Source   PDF  
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RCT 1,218 outpatients in India, showing lower hospitalization, better clinical improvement, and improved viral clearance with molnupiravir.
Concerns have been raised that the mutagenic mechanism of action may create dangerous variants or cause cancer [Hadj Hassine, Swanstrom]. See [Fountain-Jones, Sanderson,] for analysis of variants potentially created by molnupiravir.
risk of hospitalization, 65.3% lower, RR 0.35, p = 0.005, treatment 9 of 608 (1.5%), control 26 of 610 (4.3%), NNT 36.
risk of no clinical improvement, 52.8% lower, RR 0.47, p = 0.01, treatment 16 of 608 (2.6%), control 34 of 610 (5.6%), NNT 34, day 14.
relative improvement in Ct value, 48.4% better, RR 0.52, p < 0.001, treatment mean 9.5 (±7.0) n=608, control mean 4.9 (±10.6) n=610, day 14.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Sinha et al., 14 Nov 2022, Randomized Controlled Trial, India, peer-reviewed, 17 authors, study period May 2021 - August 2021, average treatment delay 2.0 days, trial CTRI/2021/05/033739.
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Efficacy and Safety of Molnupiravir in Mild COVID-19 Patients in India
Shubhadeep Sinha, Vasanth Kumar Suram, Sreenivasa S Chary, Veer Sunil Naik, Veer Bahadur Singh, Manish K Jain, Chandra P Suthar, Swapnav Borthakur, Vinayak Sawardekar, Noushadali Sk, Naveen Reddy, Leela Talluri, Pankaj Thakur, Mohan Reddy, Muralidhar Panapakam, Ramya Vattipalli
Cureus, doi:10.7759/cureus.31508
Background At the peak of the coronavirus disease 2019 (COVID-19) pandemic, the need for an orally administered agent to prevent the progression of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection became increasingly evident, which was the impetus behind our investigations with molnupiravir. Molnupiravir has been shown to be effective in preventing hospitalizations and/or clinical complications in patients with mild-to-moderate COVID-19. In this study, we evaluate the efficacy and safety of molnupiravir in Indian patients with mild SARS-CoV-2 infection and at least one risk factor for disease progression (CTRI/2021/05/033739). Methodology This was a phase III, multicenter, randomized, open-label, controlled study conducted in Indian adults aged 18-60 years with mild SARS-CoV-2, reverse transcription polymerase chain reaction (RT-PCR)-positive within 48 hours of enrollment in the study, and within five days of first symptom onset. Enrolled patients were randomized to treatment arms in a 1:1 ratio to receive molnupiravir or placebo in addition to the standard of care (SoC) for SARS-CoV-2 infection. The SoC was in compliance with Government of India guidelines that were in force at the time. The primary endpoint was the rate of hospitalization up to day 14. Safety endpoints included incidence of adverse events (AEs). Results Eligible patients were randomized in a 1:1 ratio to receive molnupiravir in addition to SoC treatment (n = 608) or SoC alone (n = 610). In the molnupiravir group, nine (1.48%) patients required hospitalization versus 26 (4.26%) patients in the control group (risk difference = -2.78%; 95% CI = -4.65, -0.90; p = 0.0053). Overall, 45 (3.70%) patients reported 47 AEs during the study, most of which were mild and resolved completely. The molnupiravir group reported 30 AEs compared to 17 AEs in the control group. Headache and nausea were the two most commonly reported AEs. Conclusions The molnupiravir arm showed a lower rate of hospitalization and a shorter time for the improvement of clinical symptoms coupled with early RT-PCR negativity. Molnupiravir was well tolerated, and AEs were mild and rare. The addition of molnupiravir to standard therapy has the potential to prevent the progression of mild COVID-19 disease to the severe form.
Additional Information
Cox, Wolf, Plemper, Therapeutically administered ribonucleoside analogue MK-4482/EIDD-2801 blocks SARS-CoV-2 transmission in ferrets, Nat Microbiol, doi:10.1038/s41564-020-00835-2
Fischer Wa 2nd, Eron, Jr, Holman, A phase 2a clinical trial of molnupiravir in patients with COVID-19 shows accelerated SARS-CoV-2 RNA clearance and elimination of infectious virus, Sci Transl Med, doi:10.1126/scitranslmed.abl7430
Fischer, Eron, Holman, Molnupiravir, an oral antiviral treatment for COVID-19, medRxiv, doi:10.1101/2021.06.17.21258639
Iec Maharaja, Hospital, Ethics committee; Virinchi Hospitals Institutional Ethics Committee; Institutional Ethics Committee GGMC issued
Painter, Holman, Bush, Human safety, tolerability, and pharmacokinetics of molnupiravir, a novel broad-spectrum oral antiviral agent with activity against SARS-CoV-2, Antimicrob Agents Chemother, doi:10.1128/AAC.02428-20
Singh, Singh, Singh, Misra, An updated practical guideline on use of molnupiravir and comparison with agents having emergency use authorization for treatment of COVID-19, Diabetes Metab Syndr, doi:10.1016/j.dsx.2022.102396
Vasudevan, Ahlqvist, Mcgeough, A concise route to MK-4482 (EIDD-2801) from cytidine, Chem Commun (Camb), doi:10.1039/d0cc05944g
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