Molnupiravir Leads To Quicker Recovery In Vaccinated Adults Infected With Covid: Study In Lancet

The study also found that molnupiravir does not reduce hospitalisation or death in vaccinated adults infected with Covid-19, who are at a higher risk of mortality. 

Molnupiravir leads to quicker recovery in vaccinated adults infected with Covid-19, compared to individuals who did not consume the pills, according to a new study published in The Lancet journal. As part of the new study, infected individuals were asked to consume 800 milligrams of the antiviral twice daily for five days to relieve themselves of the symptoms of Covid-19. The study also found that molnupiravir does not reduce hospitalisation or death in vaccinated adults infected with Covid-19, who are at a higher risk of mortality. 

Quicker recovery in patients treated with molnupiravir

The study authors used statistical modelling to find the range of recovery times across both groups, and observed that patients consuming molnupiravir recovered about 4.2 days quicker on average, compared to patients in the control group. 

How is the new study unique?

According to previous research, molnupiravir, one of the most expensive antivirals used to treat Covid-19, is effective at reducing hospitalisation risk in patients with mild to moderate disease. The World Health Organization (WHO) recommends the use of molnupiravir for patients with the highest risk of hospital admission. So far, studies were conducted in largely unvaccinated populations, and prior to the emergence of the Omicron variant. The new study is unique because it was conducted in a majorly vaccinated population where most Covid-19 infections were caused due to the Omicron variant. Therefore, the study is more applicable to the present situation in the United Kingdom.

Molnupiravir is an expensive antiviral

A seven-day course of molnupiravir costs around $700 in the United States, equivalent to £577. Meanwhile, a five-day course of Paxlovid costs around $530/£437. As part of the study, the researchers sent molnupiravir directly to the trial participants, and hence, they were able to consume it directly at home. 

Secondary benefits offered by molnupiravir

In a statement released by The Lancet, Professor Chris Butler, University of Oxford, the lead author on the paper, said although this trial found no benefit from molnupiravir treatment on its primary outcome, the trial suggests that the treatment could have other benefits when being used to treat Covid-19, such as faster recovery time and reduced follow-up with health services. It was hypothesised that treatment with molnupiravir for vaccinated, at-risk patients would reduce the likelihood of hospitalisation or death. 

A faster recovery time and reduced follow-up with health services could help to ease the burden on UK health services through the treatment of selected patients at home, during times of high disease burden and pressure on key services, Butler said. 

Using this new evidence, policymakers might be able to prepare strategies for managing Covid-19 infections over the winter. 

How the study was conducted

The researchers analysed 25,708 participants over 18 years of age, as part of the study. The average age of the participants was 57 years. All the participants had a higher risk of death or hospitalisation from Covid-19 infections and had enrolled in health centres across the UK. 

If patients were aged 50 years or older, they were considered at higher risk of hospitalisation or death. Also, patients aged 18 years or above with relevant underlying health conditions were considered at higher risk of hospitalisation or death. 

According to the study, the patients had a confirmed Omicron infection and were unwell for five days or less before beginning treatment. The patients analysed were treated between December 8, 2021, and April 27, 2022, during the peak of the Omicron wave in the UK. 

As many as 12,774 patients, who accounted for approximately half of the trial participants, received 800 milligrams of molnupiravir twice daily for five days. They consumed the antiviral at home, and also received standard care. However, the remaining patients, who constituted the control group, received standard care only.

What did the study aim to find?

The main aim of the study was to determine whether molnupiravir reduced the risk of hospitalisation or death. The secondary aim of the study was related to recovery time and symptoms. These factors are planned outcome measures not as important as the primary outcome measure, but are still of interest in evaluating the effect of an intervention. During 28 days of follow-up, the patients reported results using an online daily diary. 

Findings of the study

No benefit in hospitalisation or death rates was observed in the molnupiravir group, compared to the control group. There were 105 cases of death or hospitalisation in the group treated with molnupiravir. Meanwhile, in the control group, there were 98 cases of death or hospitalisation. Both the instances accounted for 0.8 per cent of the participants in their respective groups. 

The study found that participants receiving molnupiravir reported more favourable outcomes for a variety of secondary outcomes. For the patients who consumed molnupiravir, the median average length of illness was nine days, while that for the patients in the control group was 15 days.

In the control group, seven patients did not reach recovery within the 28 days of follow-up. 

According to the study, 20 per cent of the molnupiravir patients sought general practitioner care following the trial, compared to 24 per cent of the patients in the control group. 

In the statement, Professor Ly-Mee Yu, one of the co-authors on the paper, said as countries move forward with their strategies to manage successive waves of Covid-19 infections, the issue of antibiotic resistance must not be forgotten. She added that while it is critical to ensure patients who are likely to be benefitted with antiviral treatments, such as molnupiravir, receive them, one must also understand that using antivirals to treat patients who are unlikely to be benefitted carries the risk of further driving antimicrobial resistance, wasting resources, and exposing people to unnecessary harm.

Molnupiravir might help reduce burden on healthcare services

The benefits of molnupiravir use need to be considered in the context of the burden on healthcare services and cost-effectiveness, the authors noted in the study. In order to determine the effect of Covid-19 treatment with molnupiravir on longer-term symptoms, participants are being monitored, and further health and economic analyses are being conducted.