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All Studies   All Outcomes   Recent:  
0 0.5 1 1.5 2+ Death/hospitalization -285% Improvement Relative Risk Molnupiravir  Zheng et al.  EARLY TREATMENT Is early treatment with molnupiravir beneficial for COVID-19? Retrospective 5,638 patients in the United Kingdom (Feb - Oct 2022) Study compares with paxlovid, results vs. placebo may differ Higher death/hosp. with molnupiravir (p=0.004) Zheng et al., medRxiv, January 2023 Favors molnupiravir Favors paxlovid

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

Zheng et al., medRxiv, doi:10.1101/2023.01.20.23284849
Jan 2023  
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OpenSAFELY retrospective 5,638 outpatients in the UK, showing significantly higher hospitalization/death for molnupiravir compared with paxlovid.
Concerns have been raised that the mutagenic mechanism of action may create dangerous variants or cause cancer Hadj Hassine, Huntsman, Marikawa, Swanstrom, Waters, Zibat. Multiple analyses have identifed variants potentially created by molnupiravir Fountain-Jones, Sanderson, This study is excluded in the after exclusion results of meta analysis: study compares against another treatment showing significant efficacy.
This study includes molnupiravir, sotrovimab, and paxlovid.
risk of death/hospitalization, 284.6% higher, HR 3.85, p = 0.004, treatment 11 of 802 (1.4%), control 33 of 4,836 (0.7%), inverted to make HR<1 favor treatment, COVID-19 related, propensity score weighting, Cox proportional hazards, day 28, model 4.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Zheng et al., 22 Jan 2023, retrospective, United Kingdom, preprint, 9 authors, study period 11 February, 2022 - 1 October, 2022, this trial compares with another treatment - results may be better when compared to placebo.
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This PaperMolnupiravirAll
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
Bang Zheng, John Tazare, Linda Nab, Amir Mehrkar, Brian Mackenna, Ben Goldacre, Ian J Douglas, Laurie A Tomlinson
Objective: To compare the effectiveness of Paxlovid vs. sotrovimab and molnupiravir in preventing severe COVID-19 outcomes in non-hospitalised high-risk COVID-19 adult patients. Design: With the approval of NHS England, we conducted a real-world cohort study using the OpenSAFELY-TPP platform. Setting: Patient-level electronic health record data were obtained from 24 million people registered with a general practice in England that uses TPP software. The primary care data were securely linked with data on COVID-19 infection and therapeutics, hospital admission, and death within the OpenSAFELY-TPP platform, covering a period where both Paxlovid and sotrovimab were first-line treatment options in community settings. Participants: Non-hospitalised adult COVID-19 patients at high risk of severe outcomes treated
Summary In routine care of non-hospitalised high-risk adult patients with COVID-19 in England, we observed no substantial difference in the risk of severe COVID-19 outcomes between those who received Paxlovid and sotrovimab during a period of Omicron BA.2 and BA.5 dominance. . Administrative Conflicts of Interest BG has received research funding from the Laura and John Arnold Foundation, the NHS National Institute for Health Research (NIHR), the NIHR School of Primary Care Research, NHS England, the NIHR Oxford Biomedical Research Centre, the Mohn-Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, the Wellcome Trust, the Good Thinking Foundation, Health Data Research UK, the Health Foundation, the World Health Organisation, UKRI MRC, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme; he is a Non-Executive Director at NHS Digital; he also receives personal income from speaking and writing for lay audiences on the misuse of science. BMK is also employed by NHS England working on medicines policy and clinical lead for primary care medicines data.
Agarwal, Rochwerg, Lamontagne, A living WHO guideline on drugs for covid-19, BMJ
Akinosoglou, Schinas, Gogos, Oral Antiviral Treatment for COVID-19: A Comprehensive Review on Nirmatrelvir/Ritonavir, Viruses
Arbel, Sagy, Hoshen, Nirmatrelvir Use and Severe Covid-19 Outcomes during the Omicron Surge, N Engl J Med
Bernal, Da Silva, Musungaie, Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients, N Engl J Med
Butler, Hobbs, Gbinigie, 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, Lancet
Dryden-Peterson, Kim, Kim, Nirmatrelvir Plus Ritonavir for Early COVID-19 in a Large U.S. Health System: A Population-Based Cohort Study, Ann Intern Med
Green, Curtis, Higgins, Trends, variation, and clinical characteristics of recipients of antiviral drugs and neutralising monoclonal antibodies for covid-19 in community settings: retrospective, descriptive cohort study of 23.4 million people in OpenSAFELY, BMJ Medicine
Gupta, Gonzalez-Rojas, Juarez, Early Treatment for Covid-19 with SARS-CoV-2
Hammond, Leister-Tebbe, Gardner, Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19, N Engl J Med, doi:10.1056/NEJMoa2118542
Nhs, Antivirals or Neutralising Antibodies for Non-Hospitalised Patients with COVID-19
Nhs, Neutralising monoclonal antibodies (nMABs) or antivirals for non-hospitalised patients with COVID-19
Stürmer, Rothman, Avorn, Glynn, Treatment effects in the presence of unmeasured confounding: dealing with observations in the tails of the propensity score distribution--a simulation study, Am J Epidemiol
Stürmer, Webster-Clark, Lund, Propensity Score Weighting and Trimming Strategies for Reducing Variance and Bias of Treatment Effect Estimates: A Simulation Study, Am J Epidemiol
Wong, Au, Lau, Lau, Cowling 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, Lancet
Wu, Carr, Harvey, WHO's Therapeutics and COVID-19 Living Guideline on mAbs needs to be reassessed, Lancet
Zheng, Green, Tazare, 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, BMJ
Please send us corrections, updates, or comments. Vaccines and treatments are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment, vaccine, or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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