Outcomes in COVID-19 molnupiravir studies
Outcomes in molnupiravir studies. Potential risks of the mechanism of action include the creation of dangerous variants, and mutagenicity, carcinogenicity, teratogenicity, and embryotoxicity. There is substantial positive publication bias. Two trials (CTRI/2021/05/033864 and CTRI/2021/08/0354242) have reported no significant efficacy, however the results have not been published.
0
0.5
1
1.5+
All studies 36% 9
4,235
Improvement, Studies, Patients Relative Risk Mortality 50% 3
1,901
Hospitalization 57% 3
2,163
Recovery 15% 5
906
Viral clearance 47% 4
1,859
RCTs 36% 9
4,235
RCT mortality 50% 3
1,901
Peer-reviewed 39% 5
3,678
Early 53% 6
3,944
Late -8% 3
291
Molnupiravir for COVID-19 c19mp.com May 2022
Favors molnupiravir Favors control
0
0.5
1
1.5+
ALL STUDIES
MORTALITY
HOSPITALIZATION
RECOVERY
VIRAL CLEARANCE
RCTS
RCT MORTALITY
PEER-REVIEWED
All
Early
Late
Molnupiravir for COVID-19
C19MP.COM MAY 2022
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Fischer (RCT) 77%
0.23 [0.01-5.69]
death
0/140
1/62
Improvement, RR [CI] Treatment Control Hetero (RCT) 70%
0.30 [0.13-0.70]
hosp.
7/371
23/370
Optimus (RCT) 58%
0.42 [0.31-0.58]
viral+
38/175
93/180
Khoo (RCT) -33%
1.33 [0.55-3.26]
no recov.
8/12
3/6
Jayk Bernal (RCT) 89%
0.11 [0.01-0.86]
death
1/709
9/699
Tippabhotla (RCT) 46%
0.54 [0.22-1.34]
hosp.
7/610
13/610
Tau2 = 0.14, I2 = 43.2%, p = 0.0027
Early treatment 53%
0.47 [0.29-0.77]
61/2,017
142/1,927
53% improvement 033864 (RCT) 0%
1.00 [0.50-2.00]
improv.
n/a
n/a
FUTILITY, PENDING1
Improvement, RR [CI] Treatment Control 035424 (RCT) 0%
1.00 [0.50-2.00]
improv.
n/a
n/a
FUTILITY, PENDING1
Arribas (DB RCT) -282%
3.82 [0.50-29.1]
death
11/216
1/75
Tau2 = 0.00, I2 = 0.0%, p = 0.77
Late treatment -8%
1.08 [0.67-1.73]
11/216
1/75
-8% improvement All studies 36%
0.64 [0.40-1.03]
72/2,233
143/2,002
36% improvement 9 molnupiravir COVID-19 studies c19mp.com May 2022
Tau2 = 0.26, I2 = 60.7%, p = 0.066
Effect extraction pre-specified
1 FUTILITY: terminated for futility, results pending Favors molnupiravir
Favors control
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Fischer (RCT) 77%
0.23 [0.01-5.69]
0/140
1/62
Improvement, RR [CI] Treatment Control Jayk Bernal (RCT) 89%
0.11 [0.01-0.86]
1/709
9/699
Tau2 = 0.00, I2 = 0.0%, p = 0.024
Early treatment 86%
0.14 [0.02-0.78]
1/849
10/761
86% improvement Arribas (DB RCT) -282%
3.82 [0.50-29.1]
11/216
1/75
Improvement, RR [CI] Treatment Control Tau2 = 0.00, I2 = 0.0%, p = 0.2
Late treatment -282%
3.82 [0.50-29.1]
11/216
1/75
-282% improvement All studies 50%
0.50 [0.05-5.45]
12/1,065
11/836
50% improvement 3 molnupiravir COVID-19 mortality results c19mp.com May 2022
Tau2 = 2.97, I2 = 67.3%, p = 0.58
Favors molnupiravir
Favors control
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Fischer (RCT) -33%
1.33 [0.14-12.5]
hosp.
3/140
1/62
Improvement, RR [CI] Treatment Control Hetero (RCT) 70%
0.30 [0.13-0.70]
hosp.
7/371
23/370
Tippabhotla (RCT) 46%
0.54 [0.22-1.34]
hosp.
7/610
13/610
Tau2 = 0.00, I2 = 0.0%, p = 0.0052
Early treatment 57%
0.43 [0.24-0.78]
17/1,121
37/1,042
57% improvement All studies 57%
0.43 [0.24-0.78]
17/1,121
37/1,042
57% improvement 3 molnupiravir COVID-19 hospitalization results c19mp.com May 2022
Tau2 = 0.00, I2 = 0.0%, p = 0.0052
Favors molnupiravir
Favors control
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Fischer (RCT) 77%
0.23 [0.01-5.69]
death
0/140
1/62
Improvement, RR [CI] Treatment Control Hetero (RCT) 70%
0.30 [0.13-0.70]
hosp.
7/371
23/370
Jayk Bernal (RCT) 89%
0.11 [0.01-0.86]
death
1/709
9/699
Tippabhotla (RCT) 46%
0.54 [0.22-1.34]
hosp.
7/610
13/610
Tau2 = 0.00, I2 = 0.0%, p = 0.00042
Early treatment 65%
0.35 [0.20-0.63]
15/1,830
46/1,741
65% improvement Arribas (DB RCT) -282%
3.82 [0.50-29.1]
death
11/216
1/75
Improvement, RR [CI] Treatment Control Tau2 = 0.00, I2 = 0.0%, p = 0.2
Late treatment -282%
3.82 [0.50-29.1]
11/216
1/75
-282% improvement All studies 56%
0.44 [0.18-1.06]
26/2,046
47/1,816
56% improvement 5 molnupiravir COVID-19 serious outcomes c19mp.com May 2022
Tau2 = 0.40, I2 = 44.2%, p = 0.067
Effect extraction pre-specified (most serious outcome) Favors molnupiravir
Favors control
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Hetero (RCT) 33%
0.67 [0.54-0.82]
recov. time
371 (n)
370 (n)
Improvement, RR [CI] Treatment Control Khoo (RCT) -33%
1.33 [0.55-3.26]
no recov.
8/12
3/6
Tau2 = 0.13, I2 = 54.4%, p = 0.53
Early treatment 18%
0.82 [0.44-1.52]
8/383
3/376
18% improvement 033864 (RCT) 0%
1.00 [0.50-2.00]
improv.
n/a
n/a
FUTILITY, PENDING1
Improvement, RR [CI] Treatment Control 035424 (RCT) 0%
1.00 [0.50-2.00]
improv.
n/a
n/a
FUTILITY, PENDING1
Arribas (DB RCT) 1%
0.99 [0.68-1.45]
no recov.
72 (n)
75 (n)
Tau2 = 0.00, I2 = 0.0%, p = 0.97
Late treatment 1%
0.99 [0.74-1.34]
0/72
0/75
1% improvement All studies 15%
0.85 [0.66-1.11]
8/455
3/451
15% improvement 5 molnupiravir COVID-19 recovery results c19mp.com May 2022
Tau2 = 0.03, I2 = 35.2%, p = 0.24
1 FUTILITY: terminated for futility, results pending Favors molnupiravir
Favors control
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Fischer (RCT) 49%
0.51 [0.22-1.18]
viral+
10/118
9/54
Improvement, RR [CI] Treatment Control Optimus (RCT) 58%
0.42 [0.31-0.58]
viral+
38/175
93/180
Tippabhotla (RCT) 59%
0.41 [0.29-0.57]
viral+
42/610
103/610
Tau2 = 0.00, I2 = 0.0%, p < 0.0001
Early treatment 58%
0.42 [0.34-0.53]
90/903
205/844
58% improvement Arribas (DB RCT) 12%
0.88 [0.62-1.25]
viral+
26/52
34/60
Improvement, RR [CI] Treatment Control Tau2 = 0.00, I2 = 0.0%, p = 0.49
Late treatment 12%
0.88 [0.62-1.25]
26/52
34/60
12% improvement All studies 47%
0.53 [0.35-0.80]
116/955
239/904
47% improvement 4 molnupiravir COVID-19 viral clearance results c19mp.com May 2022
Tau2 = 0.13, I2 = 75.9%, p = 0.0024
Favors molnupiravir
Favors control
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Fischer (RCT) 77%
0.23 [0.01-5.69]
death
0/140
1/62
Improvement, RR [CI] Treatment Control Hetero (RCT) 70%
0.30 [0.13-0.70]
hosp.
7/371
23/370
Optimus (RCT) 58%
0.42 [0.31-0.58]
viral+
38/175
93/180
Khoo (RCT) -33%
1.33 [0.55-3.26]
no recov.
8/12
3/6
Jayk Bernal (RCT) 89%
0.11 [0.01-0.86]
death
1/709
9/699
Tippabhotla (RCT) 46%
0.54 [0.22-1.34]
hosp.
7/610
13/610
Tau2 = 0.14, I2 = 43.2%, p = 0.0027
Early treatment 53%
0.47 [0.29-0.77]
61/2,017
142/1,927
53% improvement 033864 (RCT) 0%
1.00 [0.50-2.00]
improv.
n/a
n/a
FUTILITY, PENDING1
Improvement, RR [CI] Treatment Control 035424 (RCT) 0%
1.00 [0.50-2.00]
improv.
n/a
n/a
FUTILITY, PENDING1
Arribas (DB RCT) -282%
3.82 [0.50-29.1]
death
11/216
1/75
Tau2 = 0.00, I2 = 0.0%, p = 0.77
Late treatment -8%
1.08 [0.67-1.73]
11/216
1/75
-8% improvement All studies 36%
0.64 [0.40-1.03]
72/2,233
143/2,002
36% improvement 9 molnupiravir COVID-19 Randomized Controlled Trials c19mp.com May 2022
Tau2 = 0.26, I2 = 60.7%, p = 0.066
Effect extraction pre-specified
1 FUTILITY: terminated for futility, results pending Favors molnupiravir
Favors control
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Fischer (RCT) 77%
0.23 [0.01-5.69]
0/140
1/62
Improvement, RR [CI] Treatment Control Jayk Bernal (RCT) 89%
0.11 [0.01-0.86]
1/709
9/699
Tau2 = 0.00, I2 = 0.0%, p = 0.024
Early treatment 86%
0.14 [0.02-0.78]
1/849
10/761
86% improvement Arribas (DB RCT) -282%
3.82 [0.50-29.1]
11/216
1/75
Improvement, RR [CI] Treatment Control Tau2 = 0.00, I2 = 0.0%, p = 0.2
Late treatment -282%
3.82 [0.50-29.1]
11/216
1/75
-282% improvement All studies 50%
0.50 [0.05-5.45]
12/1,065
11/836
50% improvement 3 molnupiravir COVID-19 RCT mortality results c19mp.com May 2022
Tau2 = 2.97, I2 = 67.3%, p = 0.58
Favors molnupiravir
Favors control
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Hetero (RCT) 70%
0.30 [0.13-0.70]
hosp.
7/371
23/370
Improvement, RR [CI] Treatment Control Khoo (RCT) -33%
1.33 [0.55-3.26]
no recov.
8/12
3/6
Jayk Bernal (RCT) 89%
0.11 [0.01-0.86]
death
1/709
9/699
Tippabhotla (RCT) 46%
0.54 [0.22-1.34]
hosp.
7/610
13/610
Tau2 = 0.46, I2 = 62.7%, p = 0.098
Early treatment 52%
0.48 [0.21-1.14]
23/1,702
48/1,685
52% improvement Arribas (DB RCT) -282%
3.82 [0.50-29.1]
death
11/216
1/75
Improvement, RR [CI] Treatment Control Tau2 = 0.00, I2 = 0.0%, p = 0.2
Late treatment -282%
3.82 [0.50-29.1]
11/216
1/75
-282% improvement All studies 39%
0.61 [0.25-1.49]
34/1,918
49/1,760
39% improvement 5 molnupiravir COVID-19 peer reviewed trials c19mp.com May 2022
Tau2 = 0.61, I2 = 65.2%, p = 0.28
Effect extraction pre-specified (most serious outcome) Favors molnupiravir
Favors control
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Fischer (RCT) 77%
0.23 [0.01-5.69]
death
0/140
1/62
Improvement, RR [CI] Treatment Control Fischer (RCT) 65%
0.35 [0.01-8.33]
death
0/55
1/62
Fischer (RCT) 67%
0.33 [0.01-8.03]
death
0/62
1/62
Fischer (RCT) 58%
0.42 [0.02-10.0]
death
0/23
1/62
Fischer (RCT) -33%
1.33 [0.14-12.5]
hosp.
3/140
1/62
Fischer (RCT) -13%
1.13 [0.07-17.6]
hosp.
1/55
1/62
Fischer (RCT) -100%
2.00 [0.19-21.5]
hosp.
2/62
1/62
Fischer (RCT) 58%
0.42 [0.02-10.0]
hosp.
0/23
1/62
Fischer (RCT) 49%
0.51 [0.22-1.18]
viral+
10/118
9/54
Fischer (RCT) 89%
0.11 [0.01-0.86]
viral+
1/53
9/54
Fischer (RCT) 30%
0.70 [0.25-1.93]
viral+
5/43
9/54
Fischer (RCT) -9%
1.09 [0.37-3.18]
viral+
4/22
9/54
Fischer (RCT) 92%
0.08 [0.01-0.62]
viral+
1/117
6/54
Fischer (RCT) 92%
0.08 [0.00-1.34]
viral+
0/53
6/54
Fischer (RCT) 91%
0.09 [0.00-1.48]
viral+
0/42
6/54
Fischer (RCT) 59%
0.41 [0.05-3.20]
viral+
1/22
6/54
Fischer (RCT) 30%
0.70 [0.37-1.36]
viral+
19/137
12/61
Fischer (RCT) 62%
0.38 [0.13-1.12]
viral+
4/53
12/61
Fischer (RCT) -8%
1.08 [0.54-2.18]
viral+
13/61
12/61
Fischer (RCT) 56%
0.44 [0.11-1.83]
viral+
2/23
12/61
Hetero (RCT) 70%
0.30 [0.13-0.70]
hosp.
7/371
23/370
Hetero (RCT) 33%
0.67 [0.54-0.82]
recov. time
371 (n)
370 (n)
Optimus (RCT) 58%
0.42 [0.31-0.58]
viral+
38/175
93/180
Khoo (RCT) -33%
1.33 [0.55-3.26]
no recov.
8/12
3/6
Khoo (RCT) -100%
2.00 [0.28-14.2]
no recov.
4/12
1/6
Khoo (RCT) -100%
2.00 [0.90-4.43]
no recov.
4/4
3/6
Khoo (RCT) 0%
1.00 [0.28-3.54]
no recov.
2/4
3/6
Khoo (RCT) 0%
1.00 [0.28-3.54]
no recov.
2/4
3/6
Khoo (RCT) -50%
1.50 [0.13-17.7]
no recov.
1/4
1/6
Khoo (RCT) -200%
3.00 [0.39-23.1]
no recov.
2/4
1/6
Khoo (RCT) -50%
1.50 [0.13-17.7]
no recov.
1/4
1/6
Jayk Bernal (RCT) 89%
0.11 [0.01-0.86]
death
1/709
9/699
Jayk Bernal (RCT) 30%
0.70 [0.49-0.99]
death/hosp.
48/709
68/699
Jayk Bernal (RCT) 94%
0.06 [0.00-0.97]
death/hosp.
0/37
9/47
Jayk Bernal (RCT) 50%
0.50 [0.20-1.26]
death/hosp.
6/75
13/82
Jayk Bernal (RCT) 24%
0.76 [0.42-1.38]
death/hosp.
18/237
22/221
Jayk Bernal (RCT) 42%
0.58 [0.20-1.68]
death/hosp.
5/47
7/38
Tippabhotla (RCT) 46%
0.54 [0.22-1.34]
hosp.
7/610
13/610
Tippabhotla (RCT) 46%
0.54 [0.41-0.71]
no improv.
67/610
125/610
Tippabhotla (RCT) 52%
0.48 [0.42-0.54]
no improv.
199/610
417/610
Tippabhotla (RCT) 25%
0.75 [0.71-0.79]
no improv.
433/610
576/610
Tippabhotla (RCT) 59%
0.41 [0.29-0.57]
viral+
42/610
103/610
Tippabhotla (RCT) 81%
0.19 [0.15-0.24]
viral+
62/610
327/610
Tippabhotla (RCT) 78%
0.22 [0.19-0.27]
viral+
113/610
505/610
033864 (RCT) 0%
1.00 [0.50-2.00]
improv.
n/a
n/a
FUTILITY, PENDING1
035424 (RCT) 0%
1.00 [0.50-2.00]
improv.
n/a
n/a
FUTILITY, PENDING1
Arribas (DB RCT) -282%
3.82 [0.50-29.1]
death
11/216
1/75
Arribas (DB RCT) -217%
3.17 [0.34-29.8]
death
3/71
1/75
Arribas (DB RCT) -317%
4.17 [0.48-36.4]
death
4/72
1/75
Arribas (DB RCT) -311%
4.11 [0.47-35.9]
death
4/73
1/75
Arribas (DB RCT) 1%
0.99 [0.68-1.45]
no recov.
72 (n)
75 (n)
Arribas (DB RCT) 12%
0.88 [0.61-1.28]
no recov.
73 (n)
75 (n)
Arribas (DB RCT) -1%
1.01 [0.69-1.47]
no recov.
73 (n)
75 (n)
Arribas (DB RCT) 12%
0.88 [0.62-1.25]
viral+
26/52
34/60
Arribas (DB RCT) -2%
1.02 [0.74-1.41]
viral+
29/50
34/60
Arribas (DB RCT) 21%
0.79 [0.56-1.13]
viral+
27/60
34/60
Arribas (DB RCT) 8%
0.92 [0.41-2.08]
viral+
9/53
10/54
Arribas (DB RCT) -48%
1.48 [0.72-3.03]
viral+
14/51
10/54
Arribas (DB RCT) 21%
0.79 [0.34-1.84]
viral+
8/55
10/54
molnupiravir COVID-19 outcomes c19mp.com May 2022
1 FUTILITY: terminated for futility, results pending Favors molnupiravir
Favors control
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