Should molnupiravir be used for covid-19 outpatient management in individuals at high risk for disease severity? A systematic review and meta-analysis of randomized controlled trials

Abstract

There is currently no consensus on whether to initiate molnupiravir treatment for all outpatients at high risk of severe SARS-CoV-2 infection. PubMed, Embase and Cochrane databases were systematically searched for studies that allocated COVID-19 high-risk, non-hospitalized patients to molnupiravir or a control. We computed risk ratios (RR) for binary endpoints, with 95% confidence intervals (CI), random effects model was used and a p-value <0.05 was considered as statistically significant. We analyzed data into Review Manager 5.4. We included seven randomized studies, with total of 31,569 patients , of whom 15,706 (50.8%) underwent molnupiravir therapy. Molnupiravir therapy was associated with a significant reduction in all-cause mortality rate in this population compared with control (RR 0.31; 95% CI 0.12–0.80; P= 0.02; I ²: 0%) and in hospital admission (RR 0.79; 95% CI 0.66–0.94; P= 0.007; I ²: 47%). The use of molnupiravir was not associated with a significant reduction of all-cause mortality or hospital admission for subgroups including only patients with cardiovascular disease (RR 0.79; 95% CI 0.45–1.39; P= 0.41; I2: 0%) and diabetes (RR 0.85; 95% CI 0.51–1.42; P= 0.32; I2: 0%). Our results suggest that molnupiravir use might be considered in high-risk of severity disease, non-hospitalized patients.

Keywords:
Molnupiravir; COVID-19; High-risk patients