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Molnupiravir for treating COVID-19

Tatz et al., Cochrane Database of Systematic Reviews, doi:10.1002/14651858.CD015381.pub2, Oct 2025
https://c19early.org/tatz.html
Systematic review and meta-analysis of 11 RCTs with 31,272 participants showing little to no difference in mortality, hospitalization, or symptom resolution with molnupiravir, though it did increase viral clearance at day 5. Authors note substantial publication bias with 16 unpublished trials identified.
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.
Currently there are 51 molnupiravir studies and meta analysis shows:
OutcomeImprovement
Mortality13% lower [4‑22%]
Ventilation20% lower [-19‑46%]
ICU admission6% lower [-15‑23%]
Hospitalization0% lower [-7‑7%]
Cases24% fewer [-1‑43%]
Tatz et al., 28 Oct 2025, peer-reviewed, 9 authors. Contact: gayle.tatz@uct.ac.za.
Molnupiravir for treating COVID-19
Gayle S Tatz, Eleanor A Ochodo, Tilly Fox, Eddy J Owino, Bruce Nyagol, Priscilla Rupali, Michael Mccaul, Tamara Kredo, Karen Cohen
Cochrane Database of Systematic Reviews, doi:10.1002/14651858.cd015381.pub2
Cochrane Database of Systematic Reviews how long the virus stays in the body. We were unable to analyse whether molnupiravir had a different effect in certain groups of people, like those with severe pre-existing conditions or people from low-or middle-income countries. How up-to-date is the evidence? The review includes studies published up to April 2024. Ongoing research could provide more insights in the future.
The editorial base of the Cochrane Infectious Diseases Group is funded by UK aid from the UK Government for the benefit of low-and middle-income countries (project number 300342-104). The views expressed herein do not necessarily reflect the UK Government's official policies. Registration Protocol available at https://doi.org/10.1002/14651858.CD015381 . P L A I N L A N G U A G E S U M M A R Y Is molnupiravir (an antiviral medicine) safe and effective in treating people with COVID-19? Key messages • In people with mild to moderate COVID-19 who are not admitted to hospital, molnupiravir probably makes little to no difference in reducing the risk of death compared with placebo (dummy treatment) or usual care. Molnupiravir may make little to no difference in reducing the need for hospitalisation or helping people get better faster. Molnupiravir probably does not increase the risk of unwanted effects, and does not increase the risk of serious unwanted effects. • The evidence is unclear about whether molnupiravir is safe or effective in people who are admitted to hospital with COVID-19. What is molnupiravir? Molnupiravir is a pill used to treat COVID-19 in people who are at high risk of developing severe illness. It works by interfering with the ability of SARS-CoV-2 (the virus that causes COVID-19) to reproduce, helping the body to fight off the infection. What did we want to find out? We wanted to find out how molnupiravir compares to no treatment, placebo (dummy..
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