Summary of COVID-19 molnupiravir studies

592 patient molnupiravir early treatment RCT: 103% worse viral clearance (p=0.33).
PANORAMIC virology-sub-study showing increased viral persistence with molnupiravir treatment. Molnupiravir 800mg twice daily for 5 days led to faster initial viral decline but 86% still had detectable virus by day 5. By day 14, molnupiravir was associated with significantly higher proportions with detectable virus and lower anti-spike antibodies compared to usual care. Serial genome sequencing revealed substantially increased mutagenesis with molnupiravir. Viable virus was cultured from samples up to 9 days post-treatment.
Feb 2024, Nature Communications, https://www.nature.com/articles/s41467-024-45641-0, https://c19p.org/standing

2. Tare et al., The DAWN antivirals trial: process evaluation of a COVID-19 trial in general practice

25 patient molnupiravir early treatment RCT: 83% worse recovery (p=0.36).
Very small early terminated RCT with 8 molnupiravir and 17 placebo patients showing worse recovery with molnupiravir, without statistical significance.
Nov 2023, BJGP Open, http://bjgpopen.org/lookup/doi/10.3399/BJGPO.2023.0109, https://c19p.org/tare

3. Arribas et al., Randomized Trial of Molnupiravir or Placebo in Patients Hospitalized with Covid-19

291 patient molnupiravir late treatment RCT: 282% higher mortality (p=0.31), 1% improved recovery (p=0.96), and 12% improved viral clearance (p=0.57).
RCT 304 hospitalized patients, 218 treated with molnupiravir, showing no significant differences. MOVe-IN MK-4482-001. NCT04575584.
Dec 2021, NEJM Evidence, https://evidence.nejm.org/pb-assets/evidence-site/content/EVIDoa2100044.pdf, https://c19p.org/arribas

4. Razia et al., Remdesivir and molnupiravir had comparable efficacy in lung transplant recipients with mild-to-moderate COVID-19: a single center experience

83 patient molnupiravir early treatment study: 272% higher mortality (p=0.28) and 28% lower hospitalization (p=0.58).
Retrospective 113 lung transplant recipients with mild-to-moderate COVID-19 showing higher mortality with remdesivir and molnupiravir in unadjusted analysis, with statistical significance for remdesivir. mAb PrEP and treatment and the dominant variant favored molnupiravir compared with the control group, however they favored the control group compared with remdesivir.
Jul 2024, Frontiers in Transplantation, https://www.frontiersin.org/articles/10.3389/frtra.2024.1408289/full, https://c19p.org/razia

5. Butler et al., Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial

25,054 patient molnupiravir early treatment RCT: 27% higher mortality (p=0.5), 6% higher combined mortality/hospitalization (p=0.69), 7% higher hospitalization (p=0.67), and 2% lower transmission (p=0.88).
26,411 patient RCT in the UK, showing faster recovery but no significant difference in hospitalization/death or transmission. Improved recovery may be in part due to the open label design with self-reported symptomatic data. Viral load initially declined more quickly, but was higher at 14 days. Longer-term results are from [Harris].
Oct 2022, The Lancet, https://www.sciencedirect.com/science/article/pii/S0140673622025971, https://c19p.org/butler2

6. Lv et al., Clinical characteristics and outcomes of hospitalized kidney transplant recipients with COVID-19 infection in China during the Omicron wave: a single-center cohort study

324 patient molnupiravir late treatment study: 53% higher mortality (p=0.22).
Retrospective 324 hospitalized kidney transplant recipients with COVID-19 showing no significant benefit with molnupiravir, paxlovid, or azvudine. The study was conducted during the omicron wave in China between December 2022 and January 2023. Adjusted results are only provided for all antivirals combined, however the results are similar before and after adjustment. Multivariable Cox regression analysis for all antivirals combined showed an adjusted hazard ratio for mortality of 6.06, p=0.099. While adjustment includes factors related to baseline severity, there may be residual confounding by indication.
Jun 2024, J. Zhejiang University - SCIENCE B (Biomedicine & Biotechnology, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11199089/, https://c19p.org/lv3

7. Khoo et al., Optimal dose and safety of molnupiravir in patients with early SARS-CoV-2: a Phase I, open-label, dose-escalating, randomized controlled study

18 patient molnupiravir early treatment RCT: 33% worse recovery (p=0.63).
Dose and safety study of molnupiravir with 18 participants, finding no serious adverse events in short-term followup. There was no significant difference in clinical outcomes. NCT04746183.
Aug 2021, J. Antimicrobial Chemotherapy, https://academic.oup.com/jac/advance-article/doi/10.1093/jac/dkab318/6358705, https://c19p.org/khoo

8. Özdemir et al., COVID-19 enfeksi̇yonunda molnupiravi̇r tedavi̇si̇ alan hastalarin değerlendi̇ri̇lmesi̇

78 patient molnupiravir late treatment study: 50% higher mortality (p=1) and no change in ICU admission (p=1).
Retrospective study of 78 hospitalized COVID-19 patients in Turkey showing no significant difference in mortality or discharge rates with molnupiravir treatment.
Mar 2024, Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, http://dergipark.org.tr/tr/doi/10.34087/cbusbed.1423523, https://c19p.org/ozdemir

9. Horby et al., Molnupiravir or nirmatrelvir-ritonavir versus usual care in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

923 patient molnupiravir late treatment RCT: 11% higher mortality (p=0.55), 43% higher ventilation (p=0.59), 9% lower hospital discharge (p=0.46), and 12% improved viral clearance (p<0.0001).
RECOVERY RCT showing no significant differences in mortality, ventilation, or discharge with either molnupiravir (923 patients) or paxlovid (137 patients). Viral load was improved with treatment but did not translate into clinical benefit, which may in part be due to side effects of treatment. The treatment delay was notably shorter compared to other treatments in this trial - 4 and 5 days from onset for paxlovid and molnupiravir. There was an exactly one year delay in publication after completion of recruitment. No press release or results are shown on the trial web site. In contrast, a press release was issued for the HCQ arm on the same day that recruitment ended. The one year delay may be a maximum delay due to EU Clinical Trials registration and associated regulatory requirements for the release of results within 12 months.
May 2024, medRxiv, https://www.medrxiv.org/content/10.1101/2024.05.23.24307731v1, https://c19p.org/horby

10. Liu et al., Disease Progression of Hospitalized Elderly Patients with Omicron BA.2 Treated with Molnupiravir

42 patient molnupiravir early treatment study: 18% shorter hospitalization (p=0.14) and 21% faster viral clearance (p=0.1).
Retrospective 42 elderly patients in China showing faster viral clearance with molnupiravir.
Oct 2022, Infectious Diseases and Therapy, https://link.springer.com/10.1007/s40121-022-00716-7, https://c19p.org/liu5

11. Goodwin et al., Evaluation of outpatient treatment for non-hospitalised patients with COVID-19: The experience of a regional centre in the UK

416 patient molnupiravir early treatment study: 110% higher mortality (p=0.47) and 58% lower hospitalization (p=0.7).
Retrospective 604 outpatients in the UK, showing lower risk of hospitalization with molnupiravir treatment, without statistical significance due to the small number of hospitalizations.
Mar 2023, PLOS ONE, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0281915, https://c19p.org/goodwinm

12. Yip et al., Impact of the use of oral antiviral agents on the risk of hospitalization in community COVID-19 patients

88,962 patient molnupiravir early treatment study: 12% higher combined mortality/ICU admission (p=0.66) and 17% higher hospitalization (p=0.06).
Propensity score weighted retrospective of 93,883 outpatients in Hong Kong, 5,808 treated with molnupiravir and 4,921 treated with paxlovid, showing higher hospitalization and higher combined mortality/mechanical ventilation/ICU admission with molnupiravir, without statistical significance; and lower hospitalization and combined mortality/mechanical ventilation/ICU admission with paxlovid, statistically significant only for hospitalization.
May 2022, Clinical Infectious Diseases, https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciac687/6678124, https://c19p.org/yip

13. Zheng et al., Comparative effectiveness of sotrovimab and molnupiravir for prevention of severe covid-19 outcomes in patients in the community: observational cohort study with the OpenSAFELY platform

6,020 patient molnupiravir early treatment study: 100% higher combined mortality/hospitalization (p=0.005).
Retrospective 3,331 sotrovimab and 2,689 molnupiravir patients in the UK, showing higher risk of combined hospitalization/death with molnupiravir.
Nov 2022, BMJ, https://www.bmj.com/lookup/doi/10.1136/bmj-2022-071932, https://c19p.org/zheng4

14. Brown et al., Demographics and outcomes of initial phase of COVID-19 Medicines Delivery Units across 4 UK centres during peak B1.1.529 omicron epidemic: a service evaluation

664 patient molnupiravir early treatment study: 101% higher hospitalization (p=0.51).
Retrospective 442 patients in the UK treated with molnupiravir, and 222 eligible but declining treatment, showing no significant difference in hospitalization. No group details are provided and the results are subject to confounding by indication.
Oct 2022, Open Forum Infectious Diseases, https://academic.oup.com/ofid/advance-article/doi/10.1093/ofid/ofac527/6750023, https://c19p.org/brown2

15. Butt et al., Molnupiravir Use and 30-Day Hospitalizations or Death in Previously Uninfected Non-hospitalized High-risk Population with COVID-19

65,010 patient molnupiravir early treatment study: 9% higher combined mortality/hospitalization (p=0.75).
Retrospective 65,010 veterans in the USA, showing no significant difference in hospitalization/death with molnupiravir treatment. 1,729 patients received molnupiravir. Authors emulate a target trial closely matching the MOVe-OUT RCT and using 1,459 matched pairs.
May 2023, The J. Infectious Diseases, https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiad195/7187858, https://c19p.org/butt

16. Kneidinger et al., Outcome of lung transplant recipients infected with SARS-CoV-2/Omicron/B.1.1.529: a Nationwide German study

218 patient molnupiravir early treatment study: 15% higher severe cases (p=0.71).
Retrospective 218 COVID+ lung transplant patients in Germany, showing no significant difference in severe cases with early molnupiravir use.
Sep 2022, Infection, https://link.springer.com/10.1007/s15010-022-01914-8, https://c19p.org/kneidinger

17. Tazare et al., Effectiveness of Sotrovimab and Molnupiravir in community settings in England across the Omicron BA.1 and BA.2 sublineages: emulated target trials using the OpenSAFELY platform

68,640 patient molnupiravir early treatment study: 9% higher combined mortality/hospitalization (p=0.28).
OpenSAFELY retrospective 75,048 outpatients in the UK, using the clone-censor-weight approach to address immortal time bias, showing no significant difference in combined mortality/hospitalization with molnupiravir treatment.
May 2023, medRxiv, https://www.medrxiv.org/content/10.1101/2023.05.12.23289914, https://c19p.org/tazare

18. Zheng et al., Comparative effectiveness of Paxlovid versus sotrovimab and molnupiravir for preventing severe COVID-19 outcomes in non-hospitalised patients: observational cohort study using the OpenSAFELY platform

5,638 patient molnupiravir early treatment study: 285% higher combined mortality/hospitalization (p=0.004).
OpenSAFELY retrospective 5,638 outpatients in the UK, showing significantly higher hospitalization/death for molnupiravir compared with paxlovid.
Jan 2023, medRxiv, https://www.medrxiv.org/content/10.1101/2023.01.20.23284849, https://c19p.org/zheng5m

19. Inaba et al., Real-world data concerning the efficacy of molnupiravir in patients vaccinated against COVID-19 during the Omicron surge in Japan

294 patient molnupiravir early treatment study: 127% higher combined mortality/hospitalization (p=0.22) and 127% higher hospitalization (p=0.22).
Retrospective 294 consecutive patients in Japan, showing higher risk of hospitalization/death with molnupiravir, without statistical significance.
Jan 2023, Research Square, https://www.researchsquare.com/article/rs-2451986/v1, https://c19p.org/inaba

20. Suzuki et al., Real-world clinical outcomes of treatment with molnupiravir for patients with mild-to-moderate coronavirus disease 2019 during the Omicron variant pandemic

920 patient molnupiravir early treatment PSM study: 53% lower progression (p=0.04).
Retrospective 1,921 patients in Japan, showing lower progression with molnupiravir use.
Oct 2022, Clinical and Experimental Medicine, https://link.springer.com/10.1007/s10238-022-00949-3, https://c19p.org/suzuki2

21. Bajema et al., Effectiveness of COVID-19 treatment with nirmatrelvir-ritonavir or molnupiravir among U.S. Veterans: target trial emulation studies with one-month and six-month outcomes

1,794 patient molnupiravir early treatment PSM study: 18% lower mortality (p=0.4), 1% lower ICU admission (p=1), and 30% higher hospitalization (p=0.04).
Retrospective 112,380 high-risk patients in the USA, showing significantly higher acute or long-term care admission at 180 days with molnupiravir treatment, and no significant difference for other outcomes. The title and headers of Table S14 are conflicting but the data appears to match be title.
Dec 2022, medRxiv, https://www.medrxiv.org/content/10.1101/2022.12.05.22283134, https://c19p.org/bajemam

22. Yen et al., Predictors for cause-specific and timing of deaths in patients with COVID-19: a cohort study in Taiwan

2,196 patient molnupiravir early treatment study: 18% lower mortality (p=0.43).
Retrospective 2,196 COVID-19 patients in Taiwan (49% mild cases, 44% moderate, 7% severe) showing lower mortality with molnupiravir, without statistical significance. Authors report that all infected patients were hospitalized at the time of the study in Taiwan.
Aug 2024, BMC Infectious Diseases, https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09654-w, https://c19p.org/yen2

23. Fung et al., Nirmatrelvir and Molnupiravir and Post–COVID-19 Condition in Older Patients

261,706 patient molnupiravir long COVID study: 4% lower PASC (p=0.001).
Retrospective 8,089 molnupiravir patients in the USA showing a small reduction in long COVID with treatment. Confounding is likely significant as below, and may eliminate the benefit. Results specific to the COVID-19 code should be closer to the actual efficacy due to likely lower average severity of the additional treatment patients included based on home tests.
Oct 2023, JAMA Internal Medicine, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2811092, https://c19p.org/fung2

24. Reuters et al., Two Indian drugmakers to end trials of generic Merck pill for moderate COVID-19

molnupiravir late treatment RCT: no change in recovery (p=1).
Trial CTRI/2021/08/035424 for moderate condition patients has been reported as terminated for futility. Results are not available yet [trialsearch.who.int].
Oct 2021, Reuters, https://www.reuters.com/business/healthcare-pharmaceuticals/aurobindo-pharma-stop-molnupiravir-trial-moderate-covid-19-patients-2021-10-08/, https://c19p.org/mp5424

25. Reuters et al., Two Indian drugmakers to end trials of generic Merck pill for moderate COVID-19

molnupiravir late treatment RCT: no change in recovery (p=1).
Trial CTRI/2021/05/033864 for moderate condition patients has been reported as terminated for futility. Results are not available yet [trialsearch.who.int].
Oct 2021, Reuters, https://www.reuters.com/business/healthcare-pharmaceuticals/aurobindo-pharma-stop-molnupiravir-trial-moderate-covid-19-patients-2021-10-08/, https://c19p.org/mp3864

26. Wan et al., Effectiveness of Molnupiravir and Nirmatrelvir–Ritonavir in Hospitalized Patients With COVID-19

16,495 patient molnupiravir late treatment study: 13% lower mortality (p<0.0001), 7% higher ventilation (p=0.49), and 2% higher ICU admission (p=0.9).
Target trial emulation retrospective with 16,495 patients in Hong Kong, showing lower mortality with molnupiravir, but no significant difference for ventilation and ICU admission. See also [acpjournals.org], [acpjournals.org].
Apr 2023, Annals of Internal Medicine, https://www.acpjournals.org/doi/10.7326/M22-3057, https://c19p.org/wan2

27. Najjar-Debbiny et al., Effectiveness of Molnupiravir in High Risk Patients: a Propensity Score Matched Analysis

5,322 patient molnupiravir early treatment PSM study: 19% lower mortality (p=0.48), 17% lower progression (p=0.34), and 25% lower severe cases (p=0.15).
PSM retrospective 2,661 molnupiravir patients in Israel, showing lower mortality and severe COVID-19, without statistical significance. Significant benefit was seen in some subgroups, and significant harm was seen in the <75 subgroup.
Sep 2022, Clinical Infectious Diseases, https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciac781/6708264, https://c19p.org/najjardebbiny2

28. Gentile et al., Efficacy of Molnupiravir in reducing the risk of severe outcome in patients with SARS-CoV-2 infection: a real-life full-matched case-control study (SAVALO Study).

1,382 patient molnupiravir early treatment PSM study: 4% lower mortality (p=0.79), 26% lower hospitalization (p=0.74), and 65% lower progression (p=0.01).
PSM retrospective case-control study with 1,382 SARS-CoV-2 positive outpatients in Italy, showing lower risk for a composite outcome of hospitalization, ICU admission, or death with molnupiravir, but no significant difference for mortality or hospitalization.
Sep 2024, medRxiv, https://www.medrxiv.org/content/10.1101/2024.09.09.24313305, https://c19p.org/gentile

29. Cheng et al., Effectiveness of molnupiravir and nirmatrelvir–ritonavir in CKD patients with COVID-19

9,938 patient molnupiravir early treatment study: 15% lower mortality (p=0.003), no change in oxygen therapy (p=1), and 12% lower ICU admission (p=0.52).
Retrospective emulated target trial of hospitalized COVID-19 patients with chronic kidney disease in Hong Kong showing lower mortality with molnupiravir and paxlovid treatment. No significant reduction was found in ICU admission or ventilatory support. Notably, there is no estimated benefit for ventilatory support, the outcome most directly related to severe COVID-19. The very large difference in vaccine uptake suggests major confounding issues, for example treatment decisions based on vaccine uptake, or confounding by time where control patients are more likely from earlier periods with lower vaccine uptake, which may also correspond to more dangerous variants.
Feb 2024, Kidney Int. Reports, https://www.sciencedirect.com/science/article/pii/S2468024924000986, https://c19p.org/cheng4

30. Wan et al., Molnupiravir and nirmatrelvir-ritonavir reduce mortality risk during post-acute COVID-19 phase

23,436 patient molnupiravir late treatment study: 11% lower mortality (p=0.02), 1% lower hospitalization (p=0.76), and 4% higher progression (p=0.18).
Retrospective 30,040 hospitalized patients in Hong Kong, showing lower mortality with molnupiravir treatment.
Feb 2023, J. Infection, https://www.sciencedirect.com/science/article/pii/S0163445323001172, https://c19p.org/wanm

31. Lai et al., Efficacy of COVID-19 Oral antivirals in hospitalised oldest-old with high morbidity burden: a target trial emulation study

13,642 patient molnupiravir late treatment study: 10% lower mortality (p=0.007).
Target trial emulation study of 13,642 (molnupiravir) and 9,553 (paxlovid) elderly hospitalized patients in Hong Kong showing lower mortality with treatment.
Aug 2024, Age and Ageing, https://academic.oup.com/ageing/article/doi/10.1093/ageing/afae180/7733454, https://c19p.org/lai2

32. Flisiak et al., Real-world experience with molnupiravir during the period of SARS-CoV-2 Omicron variant dominance

590 patient molnupiravir early treatment study: 39% lower mortality (p=0.03), 5% lower ventilation (p=1), and 1% longer hospitalization (p=0.97).
Retrospective 590 patients in Poland, 203 treated with mulnupiravir, showing lower mortality with treatment.
Jul 2022, Pharmacological Reports, https://link.springer.com/10.1007/s43440-022-00408-6, https://c19p.org/flisiak2

33. Alpizar et al., Molnupiravir for Intra-Household Prevention of COVID-19: the MOVe-AHEAD Randomized, Placebo-Controlled Trial

1,527 patient molnupiravir prophylaxis RCT: 24% fewer symptomatic cases (p=0.06).
PEP RCT 1,527 patients showing lower COVID-19 cases with molnupiravir, without statistical significance.
Sep 2023, J. Infection, https://www.journalofinfection.com/article/S0163-4453(23)00500-5/fulltext, https://c19p.org/alpizar

34. Fischer et al., Molnupiravir, an Oral Antiviral Treatment for COVID-19

202 patient molnupiravir early treatment RCT: 77% lower mortality (p=0.31) and 49% improved viral clearance (p=0.12).
RCT 202 outpatients in the USA showing significantly faster viral clearance, but no significant differences in symptom duration or severity. NCT04405570.
Jun 2021, medRxiv, https://www.medrxiv.org/content/10.1101/2021.06.17.21258639v1, https://c19p.org/fischer

35. Evans et al., Real-world effectiveness of molnupiravir, nirmatrelvir-ritonavir, and sotrovimab on preventing hospital admission among higher-risk patients with COVID-19 in Wales: A retrospective cohort study

5,332 patient molnupiravir early treatment study: 51% lower combined mortality/hospitalization (p=0.008).
Retrospective high risk outpatients in the UK, showing lower hospitalization/death with molnupiravir treatment. Residual confounding is likely with adjustments having no detail on specific comorbidities.
Jan 2023, J. Infection, https://www.sciencedirect.com/science/article/pii/S0163445323000828, https://c19p.org/evans2m

36. Arbel et al., Molnupiravir Use and Severe Covid-19 Outcomes During the Omicron Surge

19,868 patient molnupiravir early treatment study: 74% lower mortality (p=0.008) and 45% lower hospitalization (p=0.01).
Retrospective 19,868 patients eligible for molnupiravir treatment in Israel with 1,069 treated, showing lower mortality and hospitalization with treatment for the subgroup of patients ≥65, and higher mortality for patients 40-64. Authors only provide subgroup results.
Sep 2022, New England J. Medicine, https://www.nejm.org/doi/full/10.1056/NEJMoa2204919, https://c19p.org/arbel3

37. Zou et al., Antiviral Efficacy and Safety of Molnupiravir Against Omicron Variant Infection: A Randomized Controlled Clinical Trial

108 patient molnupiravir early treatment RCT: 29% faster recovery (p=0.5) and 10% faster viral clearance (p=0.009).
RCT 116 mild/moderate COVID-19 patients in China, showing improved viral clearance with treatment.
Jun 2022, Frontiers in Pharmacology, https://www.frontiersin.org/articles/10.3389/fphar.2022.939573/full, https://c19p.org/zou

38. Wong et al., Real-world effectiveness of molnupiravir and nirmatrelvir plus ritonavir against mortality, hospitalisation, and in-hospital outcomes among community-dwelling, ambulatory patients with confirmed SARS-CoV-2 infection during the omicron wave in Hong Kong: an observational study

54,217 patient molnupiravir early treatment PSM study: 24% lower mortality (p=0.01), 60% lower ventilation (p=0.02), 26% lower ICU admission (p=0.24), and 2% lower hospitalization (p=0.58).
PSM retrospective 1,074,856 outpatients in Hong Kong, showing lower mortality with molnupiravir.
Oct 2022, The Lancet, https://www.sciencedirect.com/science/article/pii/S0140673622015860, https://c19p.org/wong5m

39. Wong et al., Real-world effectiveness of early molnupiravir or nirmatrelvir–ritonavir in hospitalised patients with COVID-19 without supplemental oxygen requirement on admission during Hong Kong's omicron BA.2 wave: a retrospective cohort study

3,712 patient molnupiravir early treatment PSM study: 52% lower mortality (p<0.0001), 58% lower ventilation (p=0.06), 40% lower progression (p<0.0001), and 6% shorter hospitalization (p=0.03).
PSM retrospective 40,776 patients in Hong Kong, showing lower mortality and lower combined mortality, ventilation, ICU, and oxygen therapy with molnupiravir treatment.
May 2022, The Lancet Infectious Diseases, https://www.sciencedirect.com/science/article/pii/S1473309922005072, https://c19p.org/wong3

40. Khoo et al., Molnupiravir versus placebo in unvaccinated and vaccinated patients with early SARS-CoV-2 infection in the UK (AGILE CST-2): a randomised, placebo-controlled, double-blind, phase 2 trial

180 patient molnupiravir early treatment RCT: 89% lower hospitalization (p=0.12), 12% worse recovery (p=0.74), and 23% improved viral clearance (p=0.07).
RCT 90 molnupiravir and 90 placebo patients, showing faster viral clearance with treatment, not reaching the pre-defined threshold for superiority and recommendation as a candidate for large scale evaluation.
Jul 2022, The Lancet Infectious Diseases, https://www.sciencedirect.com/science/article/pii/S1473309922006442, https://c19p.org/khoo2

41. Optimus et al., Optimus announces Interim Clinical Results from Phase III Clinical Trials of Molnupiravir conducted in India

355 patient molnupiravir early treatment RCT: 58% improved viral clearance (p<0.0001).
Interim report on CTRI/2021/06/033992, showing faster viral clearance. Event counts are approximate, the press release only provides percentages.
Jul 2021, Optimus, Press Release, https://theprint.in/ani-press-releases/optimus-announces-interim-clinical-results-from-phase-iii-clinical-trials-of-molnupiravir-conducted-in-india/699993/, https://c19p.org/optimus

42. Tippabhotla et al., Efficacy and Safety of Molnupiravir for the Treatment of Non-Hospitalized Adults With Mild COVID-19: A Randomized, Open-Label, Parallel-Group Phase 3 Trial

1,220 patient molnupiravir early treatment RCT: 46% lower hospitalization (p=0.26), 46% greater improvement (p<0.0001), and 59% improved viral clearance (p<0.0001).
RCT 1,220 patients in India, showing lower risk of hospitalization and improved recovery with treatment. CTRI/2021/07/034588.
Feb 2022, SSRN Electronic J., https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4042673, https://c19p.org/tippabhotla

43. Jayk Bernal et al., Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients

1,408 patient molnupiravir early treatment RCT: 89% lower mortality (p=0.01), 30% lower combined mortality/hospitalization (p=0.05), 15% faster recovery (p=0.02), and 4% improved viral clearance (p=0.2).
Systematic review and meta analysis of outpatient RCTs, showing hospitalization RR 0.75 [0.57-0.97]. For discussion see [web.archive.org].
Dec 2021, New England J. Medicine, http://www.nejm.org/doi/pdf/10.1056/NEJMoa2116044, https://c19p.org/jaykbernal

44. Hetero et al., Hetero Announces Interim Clinical Results from Phase III Clinical Trials of Molnupiravir conducted in India

741 patient molnupiravir early treatment RCT: 70% lower hospitalization (p=0.003) and 33% faster recovery (p=0.0001).
Interim results for CTRI/2021/05/033739, showing lower mortality and faster recovery.
Jul 2021, Hetero, Press Release, https://www.heteroworld.com/images/Press_Release_Molnupiravir_Interim_Clinical_Results_Final_090721.pdf, https://c19p.org/hetero

45. Sinha et al., Efficacy and Safety of Molnupiravir in Mild COVID-19 Patients in India

1,218 patient molnupiravir early treatment RCT: 65% lower hospitalization (p=0.005), 53% greater improvement (p=0.01), and 48% improved viral clearance (p<0.0001).
RCT 1,218 outpatients in India, showing lower hospitalization, better clinical improvement, and improved viral clearance with molnupiravir.
Nov 2022, Cureus, https://www.cureus.com/articles/118243-efficacy-and-safety-of-molnupiravir-in-mild-covid-19-patients-in-india, https://c19p.org/sinha

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