Summary

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• This summary is based on the review of 25 systematic review(s)/meta-analysis(es). ^[1-25]
• Reduction in Hospitalization or Death: Molnupiravir reduced COVID-19-related hospitalization or death compared to placebo (odds ratio (OR), 0.67; 95% confidence interval (CI): 0.46-0.99), with an overall summary indicating reduced hospitalization risk (relative risk (RR) = 0.63; 95% CI: 0.47-0.85). In other analyses, it showed reduced mortality (RR, 0.43; 95% CI, 0.20-0.94) and a reduced risk of hospital admission (RR, 0.67; 95% CI, 0.45-0.99).
• Symptom Resolution and Viral Clearance: Molnupiravir may decrease the time to viral clearance (mean difference (MD), -1.81 days; 95% CI, -3.31 to -0.31) and to symptom resolution or clinical improvement (MD, -2.39 days; 95% CI, -3.71 to -1.07). Increased virological clearance at day 5 (RR 2.68; 95% CI: 1.94-4.22) and a higher proportion of clinical improvement (Day 5 RR 2.41; 95% CI 1.18-4.92) were also observed.
• Comparative Effectiveness: Nirmatrelvir/ritonavir had the lowest hospitalization or death risk (OR, 0.12; 95% CI: 0.06-0.24), followed by remdesivir (OR, 0.13; 95% CI: 0.03-0.57), with molnupiravir comparatively less effective (OR, 0.67; 95% CI: 0.46-0.99).
• Effectiveness in Different Populations: No benefits were observed for molnupiravir in immunized populations, with higher trial mean age and a female-majority population associated with an elevated hospitalization risk.
• Anti-viral agents, including molnupiravir, were not associated with an increased risk of adverse events compared with placebo, and molnupiravir likely does not increase serious adverse events (RR, 0.84; 95% CI, 0.61-1.15).
• Molnupiravir showed a higher incidence of adverse events compared to sotrovimab (OR = 1.67, 95% CI: 1.21, 2.30).
• Molnupiravir’s safety profile was comparable to nirmatrelvir/ritonavir and remdesivir, and it may offer a higher safety profile for oral COVID-19 treatment.
• Studies included older adults aged 60 and above, outpatients with COVID-19 across various ages, sexes, and comorbidities, both vaccinated and unvaccinated individuals, and adults with mild to moderate COVID-19 (mean age 35–56.6 years); molnupiravir demonstrated effectiveness in reducing severe outcomes particularly among older outpatients but showed no benefit in vaccinated populations.