Summary

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• Molnupiravir (Lagevrio) is indicated for the treatment of adults with a current diagnosis of mild-to-moderate COVID-19 who are at risk for progression to severe disease. It effectively reduces viral RNA load and accelerates the clearance of SARS-CoV-2 in non-hospitalized patients, showing a significant reduction in nasopharyngeal viral load.
• A total of 10 systematic reviews/meta-analyses provided insights into the safety, effectiveness, and comparative analysis of molnupiravir, including considerations for different populations and subgroups.
• Regarding hospitalization and mortality rates among non-hospitalized, mild-to-moderate COVID-19 patients at risk for progressing to severe disease, molnupiravir has been associated with reductions. However, its impact on mortality is inconsistent across studies.
• The benefits of molnupiravir are more pronounced in non-hospitalized patients, while a potential increase in mortality is noted in hospitalized patients as suggested by one study.
• Across dosages ranging from 200 to 800 mg, molnupiravir exhibits no significant increase in adverse events compared to placebo; common side effects include nausea, diarrhea, and headache. Serious adverse events do not significantly differ between those treated with molnupiravir and those receiving placebo, indicating a favorable safety profile.
• Molnupiravir shows lesser effectiveness than nirmatrelvir/ritonavir (Paxlovid) when it comes to reducing all-cause mortality, hospitalization rates, and time to viral clearance. However, Paxlovid was associated with a higher incidence of adverse events. The role of molnupiravir in vaccinated populations appears limited, requiring further investigation.