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 33% 13
15,517
Improvement, Studies, Patients Relative Risk Mortality 43% 5
13,003
Ventilation 48% 2
11,102
Hospitalization 2% 7
13,445
Recovery 15% 5
906
Viral clearance 38% 6
12,550
RCTs 37% 10
4,415
RCT mortality 50% 3
1,901
Peer-reviewed 39% 5
3,678
Early 43% 9
4,714
Late 16% 4
10,803
Molnupiravir for COVID-19 c19early.com/m Aug 2022
Favors molnupiravir Favors control
0
0.5
1
1.5+
ALL STUDIES
MORTALITY
VENTILATION
HOSPITALIZATION
RECOVERY
VIRAL CLEARANCE
RCTS
RCT MORTALITY
PEER-REVIEWED
All
Early
Late
Molnupiravir for COVID-19
C19EARLY.COM/M AUG 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
Yip (PSW) -12%
1.12 [0.68-1.82]
death/ICU
Flisiak 39%
0.61 [0.38-0.97]
death
20/203
63/387
Khoo (DB RCT) 67%
0.33 [0.01-8.08]
oxygen
0/90
1/90
Tau2 = 0.25, I2 = 71.9%, p = 0.016
Early treatment 43%
0.57 [0.36-0.90]
81/2,310
206/2,404
43% 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
Wong (PSM) 45%
0.55 [0.47-0.63]
death
2,116 (n)
8,396 (n)
Tau2 = 0.18, I2 = 64.9%, p = 0.55
Late treatment 16%
0.84 [0.49-1.45]
11/2,332
1/8,471
16% improvement All studies 33%
0.67 [0.49-0.89]
92/4,642
207/10,875
33% improvement 13 molnupiravir COVID-19 studies c19early.com/m Aug 2022
Tau2 = 0.13, I2 = 68.2%, p = 0.0069
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
Flisiak 39%
0.61 [0.38-0.97]
20/203
63/387
Tau2 = 0.32, I2 = 28.0%, p = 0.079
Early treatment 60%
0.40 [0.14-1.11]
21/1,052
73/1,148
60% improvement Arribas (DB RCT) -282%
3.82 [0.50-29.1]
11/216
1/75
Improvement, RR [CI] Treatment Control Wong (PSM) 45%
0.55 [0.47-0.63]
2,116 (n)
8,396 (n)
Tau2 = 1.34, I2 = 71.3%, p = 0.92
Late treatment -10%
1.10 [0.18-6.80]
11/2,332
1/8,471
-10% improvement All studies 43%
0.57 [0.38-0.84]
32/3,384
74/9,619
43% improvement 5 molnupiravir COVID-19 mortality results c19early.com/m Aug 2022
Tau2 = 0.06, I2 = 36.2%, p = 0.0051
Favors molnupiravir
Favors control
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Flisiak 5%
0.95 [0.39-2.32]
7/203
14/387
Improvement, RR [CI] Treatment Control Tau2 = 0.00, I2 = 0.0%, p = 0.92
Early treatment 5%
0.95 [0.39-2.32]
7/203
14/387
5% improvement Wong (PSM) 69%
0.31 [0.16-0.61]
2,116 (n)
8,396 (n)
Improvement, RR [CI] Treatment Control Tau2 = 0.00, I2 = 0.0%, p = 0.00064
Late treatment 69%
0.31 [0.16-0.61]
0/2,116
0/8,396
69% improvement All studies 48%
0.52 [0.17-1.57]
7/2,319
14/8,783
48% improvement 2 molnupiravir COVID-19 mechanical ventilation results c19early.com/m Aug 2022
Tau2 = 0.47, I2 = 74.4%, p = 0.25
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
Yip (PSW) -17%
1.17 [0.99-1.39]
hosp.
Flisiak -1%
1.01 [0.71-1.43]
hosp. time
203 (n)
387 (n)
Khoo (DB RCT) 89%
0.11 [0.01-2.03]
hosp.
0/90
4/90
Tau2 = 0.13, I2 = 67.4%, p = 0.26
Early treatment 22%
0.78 [0.51-1.20]
17/1,414
41/1,519
22% improvement Wong (PSM) 0%
1.00 [0.95-1.04]
hosp. time
2,116 (n)
8,396 (n)
Improvement, RR [CI] Treatment Control Tau2 = 0.00, I2 = 0.0%, p = 0.86
Late treatment 0%
1.00 [0.95-1.04]
0/2,116
0/8,396
0% improvement All studies 2%
0.98 [0.81-1.17]
17/3,530
41/9,915
2% improvement 7 molnupiravir COVID-19 hospitalization results c19early.com/m Aug 2022
Tau2 = 0.02, I2 = 69.8%, p = 0.81
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
Yip (PSW) -12%
1.12 [0.68-1.82]
death/ICU
Flisiak 39%
0.61 [0.38-0.97]
death
20/203
63/387
Khoo (DB RCT) 67%
0.33 [0.01-8.08]
oxygen
0/90
1/90
Tau2 = 0.25, I2 = 62.8%, p = 0.028
Early treatment 46%
0.54 [0.31-0.94]
35/2,123
110/2,218
46% improvement Arribas (DB RCT) -282%
3.82 [0.50-29.1]
death
11/216
1/75
Improvement, RR [CI] Treatment Control Wong (PSM) 45%
0.55 [0.47-0.63]
death
2,116 (n)
8,396 (n)
Tau2 = 1.34, I2 = 71.3%, p = 0.92
Late treatment -10%
1.10 [0.18-6.80]
11/2,332
1/8,471
-10% improvement All studies 39%
0.61 [0.41-0.90]
46/4,455
111/10,689
39% improvement 9 molnupiravir COVID-19 serious outcomes c19early.com/m Aug 2022
Tau2 = 0.16, I2 = 68.7%, p = 0.014
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 c19early.com/m Aug 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
Khoo (DB RCT) 23%
0.77 [0.58-1.09]
viral+
90 (n)
90 (n)
Tau2 = 0.09, I2 = 72.6%, p = 0.00035
Early treatment 49%
0.51 [0.36-0.74]
90/993
205/934
49% improvement Arribas (DB RCT) 12%
0.88 [0.62-1.25]
viral+
26/52
34/60
Improvement, RR [CI] Treatment Control Wong (PSM) 17%
0.83 [0.73-0.93]
viral+
2,115 (n)
8,396 (n)
Tau2 = 0.00, I2 = 0.0%, p = 0.0021
Late treatment 17%
0.83 [0.74-0.94]
26/2,167
34/8,456
17% improvement All studies 38%
0.62 [0.46-0.84]
116/3,160
239/9,390
38% improvement 6 molnupiravir COVID-19 viral clearance results c19early.com/m Aug 2022
Tau2 = 0.10, I2 = 82.7%, p = 0.0016
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
Khoo (DB RCT) 67%
0.33 [0.01-8.08]
oxygen
0/90
1/90
Tau2 = 0.11, I2 = 32.1%, p = 0.0009
Early treatment 54%
0.46 [0.30-0.73]
61/2,107
143/2,017
54% 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 37%
0.63 [0.40-1.00]
72/2,323
144/2,092
37% improvement 10 molnupiravir COVID-19 Randomized Controlled Trials c19early.com/m Aug 2022
Tau2 = 0.24, I2 = 56.0%, p = 0.05
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 c19early.com/m Aug 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 c19early.com/m Aug 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
Yip (PSW) -12%
1.12 [0.68-1.82]
death/ICU
Yip (PSW) -17%
1.17 [0.99-1.39]
hosp.
Flisiak 39%
0.61 [0.38-0.97]
death
20/203
63/387
Flisiak 5%
0.95 [0.39-2.32]
ventilation
7/203
14/387
Flisiak -1%
1.01 [0.71-1.43]
hosp. time
203 (n)
387 (n)
Khoo (DB RCT) 67%
0.33 [0.01-8.08]
oxygen
0/90
1/90
Khoo (DB RCT) 89%
0.11 [0.01-2.03]
hosp.
0/90
4/90
Khoo (DB RCT) 23%
0.77 [0.58-1.09]
viral+
90 (n)
90 (n)
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
Wong (PSM) 45%
0.55 [0.47-0.63]
death
2,116 (n)
8,396 (n)
Wong (PSM) 69%
0.31 [0.16-0.61]
ventilation
2,116 (n)
8,396 (n)
Wong (PSM) 47%
0.53 [0.46-0.62]
death/ICU
2,116 (n)
8,396 (n)
Wong (PSM) 0%
1.00 [0.95-1.04]
hosp. time
2,116 (n)
8,396 (n)
Wong (PSM) 17%
0.83 [0.73-0.93]
viral+
2,115 (n)
8,396 (n)
molnupiravir COVID-19 outcomes c19early.com/m Aug 2022
1 FUTILITY: terminated for futility, results pending Favors molnupiravir
Favors control
Please send us corrections, updates, or comments. Vaccines and
treatments are both valuable and complementary. All practical, effective, and
safe means should be used. No treatment, vaccine, or intervention is 100%
available and effective for all current and future variants. Denying the
efficacy of any method increases mortality, morbidity, collateral damage, and
the risk of endemic status. We do not provide medical advice. Before taking
any medication, consult a qualified physician who can provide personalized
advice and details of risks and benefits based on your medical history and
situation.
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provide treatment protocols.
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