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Molnupiravir for Early Treatment of COVID-19 in High-Risk Adults

In the U.K.-based PANORAMIC trial of high-risk vaccinated adults in the community, molnupiravir did not reduce the frequency of COVID-19-associated hospitalizations or death, researchers report. “The benefits of molnupiravir in terms of faster time to recovery, reduced contact with general practitioner services, and reduced viral load need to be considered in the context of the prevailing disease, burden on health-care services, drug-acquisition cost, social circumstances, cost-effectiveness, and opportunity costs,” the authors conclude. “Further virological and health economic analyses are underway, and participants are still being followed up to establish the effect of acute COVID-19 treatment with molnupiravir on longer-term symptoms.”

The randomized controlled trial included community-dwelling adults aged 50 years or older or 18 years or older with relevant comorbidities with symptoms of confirmed COVID-19 for 5 days or less. Treatments were molnupiravir 800 mg twice daily for 5 days plus usual care or usual care only. 

“The mean age of the population was 56.6 years (SD 12.6), and 24,290 (94%) of 25,708 participants had had at least three doses of a SARS-CoV-2 vaccine,” the authors report. “Hospitalisations or deaths were recorded in 105 (1%) of 12,529 participants in the molnupiravir plus usual care group versus 98 (1%) of 12,525 in the usual care group (adjusted odds ratio 1.06 [95% Bayesian credible interval 0.81–1.41]; probability of superiority 0.33). There was no evidence of treatment interaction between subgroups. Serious adverse events were recorded for 50 (0.4%) of 12,774 participants in the molnupiravir plus usual care group and for 45 (0.3%) of 12,934 in the usual care group. None of these events were judged to be related to molnupiravir.”

Source: Lancet