Efficacy of Molnupiravir for the Treatment of Mild or Moderate COVID-19 in Adults: A Meta-Analysis

Abstract

The aim of this meta-analysis is to evaluate the efficacy of molnupiravir among mild or moderate COVID-19 patients. This meta-analysis was reported according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two authors independently performed a comprehensive search for relevant studies in PubMed, Cochrane Library, and Web of Science. The keywords used to search for relevant records were “Molnupiravir,” “COVID-19,” and “efficacy.” This meta-analysis included studies that compared the effectiveness of molnupiravir with a placebo for COVID-19 treatment. The primary outcome assessed in this meta-analysis was the composite of hospitalization and all-cause mortality (30 days). In addition, we assessed all-cause mortality and hospitalization separately and the number of patients who tested negative for viral RNA on day five. A total of 10 studies were included in the meta-analysis. Among the 10 studies, five were randomized controlled trials and five were observational studies. Based on the results presented in the meta-analysis, it can be concluded that molnupiravir has a significant impact on reducing all-cause mortality and improving the proportion of patients who test negative for viral RNA on day five. The risk of hospitalization and composite outcome was also lower in molnupiravir-treated patients, although the difference was statistically insignificant. The subgroup analysis showed consistent results across all subgroups, indicating that the effect of molnupiravir is consistent regardless of patient characteristics.

Comparison of effectiveness and safety of molnupiravir versus sotrovimab for COVID‐19: A systematic review and meta‐analysis

“…While some meta‐analyses found no significant benefit in using molnupiravir to reduce COVID‐19‐related mortality, 21 , 43 , 44 others showed it to be effective in reducing the risk of death in COVID‐19 patients. 45 , 46 Discrepancies in these findings may be attributed to differences in inclusion criteria and the number of included studies. Current data from studies also support the effectiveness of nirmatrelvir/ritonavir and remdesivir treatments in reducing the risk of death in patients with COVID‐19.…”

“…On the other hand, the effectiveness of molnupiravir in reducing COVID‐19‐related mortality remains unclear. While some meta‐analyses found no significant benefit in using molnupiravir to reduce COVID‐19‐related mortality, 21,43,44 others showed it to be effective in reducing the risk of death in COVID‐19 patients 45,46 . Discrepancies in these findings may be attributed to differences in inclusion criteria and the number of included studies.…”

“… 20 However, the results of meta‐analyses on the therapeutic potential of molnupiravir are inconclusive and conflicting. Recent meta‐analyses conducted by Benaicha et al 45 and Gao et al 46 have shown that molnupiravir significantly reduces the hospitalization rate in COVID‐19 patients, while others have found no significant effect when compared to no treatment with molnupiravir. 43 , 44 Two other drugs approved by the FDA, nirmatrelvir/ritonavir and remdesivir, have demonstrated effectiveness in reducing the likelihood of hospitalization in patients who receive these treatments.…”

COVID-19: From Emergence to Endemicity - A Comprehensive Review

“…Molnupiravir is approved for use in non-hospitalized patients at high risk for disease progression, starting within 5 days of the onset of symptoms (269). A metaanalysis (270) showed that patients receiving molnupiravir had reduced all-cause mortality, and risk of hospitalizations, and improved proportions of patients testing negative by day 5 for viral RNA. It is recommended to be used only in situations when both remdesevir and paxlovid are not available.…”

Efficacy and safety of casirivimab-imdevimab combination on COVID-19 patients: A systematic review and meta-analysis randomized controlled trial

“…Using antiviral medications to treat patients with COVID-19, especially those with severe symptoms, is recognized as being more effective than utilizing conventional medication [ 1 , 2 ]. Among these is molnupiravir, which can reduce the risk of all-cause death and enhance the proportion of patients with negative virus status in patients with mild or moderate severity [ 3 , 4 ]. Remdesivir, which operates by inhibiting RNA-dependent RNA polymerase (RdRp) using the same mechanism of action, is recognized as being beneficial in enhancing clinical condition, lowering mortality rates, and circumventing the need for high-flow supplemental oxygen and invasive mechanical ventilation in hospitalized patients [ 5 , 6 ].…”