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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safe means should be used. No treatment, vaccine, or intervention is 100%
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