Treating COVID-19 infection with molnupiravir may help with faster recovery at home

Molnupiravir (administered at a dose of 800 mg twice daily for five days) does not reduce hospitalizations or deaths in vaccinated adults with COVID-19 infection who are at higher risk of death, according to the results of the study. a randomized controlled trial, published in the journal Fingertips Journal. However, patients treated at home with molnupiravir recovered faster than the control group.

Previous studies have shown molnupiravir to be effective in reducing hospitalizations in patients with mild to moderate COVID-19 and WHO recommends it for patients at highest risk of hospitalization. However, studies to date have been conducted in largely unvaccinated populations and prior to the appearance of the omicron variant. This new test was carried out on the majority of the vaccinated population where most COVID-19 infections are omicron variants and is therefore more applicable to the current situation in the UK.

Molnupiravir is one of the more expensive antiviral drugs used to treat COVID-19, with a seven-day course costing around $700 in the US, equivalent to £577 (versus about 530 USD/437 Pound for Paxlovid’s 5-day course). Molnuvirapir was given directly to trial participants and can be taken at home.

“Although this trial found no benefit from treatment with molnupiravir on its primary outcome—this suggests that molnupiravir treatment for vaccination of at-risk patients will reduce hospitalization or death—trials show that this treatment may have other benefits when used to treat COVID-19, such as faster recovery time and reduced follow-up with health services.”

“This could help ease the burden on the UK health services through the treatment of selected patients at home, during a time of high disease burden and pressure on primary services. We therefore hope this new evidence will be useful to policymakers as they prepare strategies for winter COVID-19 infection management,” said lead author, Professor Chris Butler, University of Oxford, UK said.

The study included 25,708 participants over the age of 18 (mean age 57 years) who were at higher risk of death or hospitalization from COVID-19 infection from medical centers across the UK. Patients are considered at higher risk of hospitalization or death if they are 50 years of age or older—or 18 years of age or older with related underlying health conditions.

The patient had confirmed omicron COVID-19 infection and was unwell for five days or less before starting treatment. The results represent the outcomes of patients treated between December 8, 2021 and April 27, 2022, during the peak of the UK omicron wave.

About half of the patients in the trial (12,774) received 800mg of molnupiravir twice daily for five days, administered at home, in addition to standard care. The control half of the trial (12,934 people) received standard care only.

The primary target being investigated is whether molnupiravir reduces the risk of hospitalization or death. Secondary goals (planned outcome measures that are not as important as the primary outcome measure but are still of interest in assessing the effectiveness of an intervention) relate to recovery time and symptoms. Patients reported results using an online daily diary for 28 days of follow-up.

No benefit was observed in hospitalization or mortality between the molnupiravir group and the control group. In the molnupiravir group there were 105 deaths or hospitalizations (0.8%), while in the control group there were 98 deaths or hospitalizations (0.8%).

Participants receiving molnupiravir reported more favorable outcomes for many of the side outcomes in this study. The median duration of illness in patients receiving molnupiravir was 9 days compared with 15 days in the control group. Using a statistical model that accounted for the time to recovery between both groups, the authors found that patients receiving molnupiravir recovered 4.2 days faster on average than patients in the control group.

In addition, seven patients in the control group did not recover within 28 days of follow-up. The number of molnupiravir-treated patients who sought GP care after the trial was slightly lower (20% of molnupiravir versus 24% of patients). control group).

“As countries work out their strategies for managing successive waves of COVID-19 infections, the issue of antibiotic resistance must not be forgotten. Although it is important to ensure that patients who are likely to receive it treatment with antiviral treatments, such as molnuvirapir, get them; use antivirals to treat patient Those who are not able to benefit run the risk of further fueling antibiotic resistance, wasting resources and exposing people to unnecessary harm.”

“Our study thus contributes to a valuable evidence base on who should not be treated with these newly discovered valuable agents, to empower clinicians to make decisions based on solid evidence when prescribing treatment for COVID-19 infection,” said study co-author. , Professor Ly-Mee Yu, University of Oxford, UK.

The authors note that the benefits of using molnupiravir need to be considered in the context of burden on health care services and cost-effectiveness. Further health and economic analyzes are underway and participants are still being monitored to determine the effectiveness of molnupiravir COVID-19 treatment on long-term symptoms.

The authors also acknowledge that the open-label design of the trial meant that they could not estimate the positive effect of molnupiravir on symptoms due to any placebo effect. However, this limitation is unlikely to affect the trial’s primary measure of hospitalization and/or death.

Writing in a Linked Comment, Professor Michael Kidd, Australian Government Department of Health and Aged Care, Canberra, Australia, who was not involved in the study, said: “Butler and colleagues redundant acknowledged that their findings may be ‘less applicable’ in people with those who are clinically extremely vulnerable to COVID-19. We would take it a step further and call for caution when seeks to apply the findings of this study to those most at risk of complications from COVID-19…Although PANORAMIC was not provided for secondary outcomes, there are experimentally important results. showed that the addition of molnupiravir to routine care resulted in a faster recovery time and reduced viral load and detectability (in a small virological substudy).”

“Short- and long-term symptom relief, along with effects on viral clearance, can be an important consideration in high-risk settings, such as nursing homes, about its ability to reduce the spread of infection in high-risk populations.Molnupiravir could also benefit health care systems, especially during times of community spikes, by potentially allowing healthcare workers to return to work safely sooner.”