Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients
Copyright © 2021 Massachusetts Medical Society..
BACKGROUND: New treatments are needed to reduce the risk of progression of coronavirus disease 2019 (Covid-19). Molnupiravir is an oral, small-molecule antiviral prodrug that is active against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
METHODS: We conducted a phase 3, double-blind, randomized, placebo-controlled trial to evaluate the efficacy and safety of treatment with molnupiravir started within 5 days after the onset of signs or symptoms in nonhospitalized, unvaccinated adults with mild-to-moderate, laboratory-confirmed Covid-19 and at least one risk factor for severe Covid-19 illness. Participants in the trial were randomly assigned to receive 800 mg of molnupiravir or placebo twice daily for 5 days. The primary efficacy end point was the incidence hospitalization or death at day 29; the incidence of adverse events was the primary safety end point. A planned interim analysis was performed when 50% of 1550 participants (target enrollment) had been followed through day 29.
RESULTS: A total of 1433 participants underwent randomization; 716 were assigned to receive molnupiravir and 717 to receive placebo. With the exception of an imbalance in sex, baseline characteristics were similar in the two groups. The superiority of molnupiravir was demonstrated at the interim analysis; the risk of hospitalization for any cause or death through day 29 was lower with molnupiravir (28 of 385 participants [7.3%]) than with placebo (53 of 377 [14.1%]) (difference, -6.8 percentage points; 95% confidence interval [CI], -11.3 to -2.4; P = 0.001). In the analysis of all participants who had undergone randomization, the percentage of participants who were hospitalized or died through day 29 was lower in the molnupiravir group than in the placebo group (6.8% [48 of 709] vs. 9.7% [68 of 699]; difference, -3.0 percentage points; 95% CI, -5.9 to -0.1). Results of subgroup analyses were largely consistent with these overall results; in some subgroups, such as patients with evidence of previous SARS-CoV-2 infection, those with low baseline viral load, and those with diabetes, the point estimate for the difference favored placebo. One death was reported in the molnupiravir group and 9 were reported in the placebo group through day 29. Adverse events were reported in 216 of 710 participants (30.4%) in the molnupiravir group and 231 of 701 (33.0%) in the placebo group.
CONCLUSIONS: Early treatment with molnupiravir reduced the risk of hospitalization or death in at-risk, unvaccinated adults with Covid-19. (Funded by Merck Sharp and Dohme; MOVe-OUT ClinicalTrials.gov number, NCT04575597.).
| Errataetall: |
CommentIn: N Engl J Med. 2022 Feb 10;386(6):592-593. - PMID 34914869 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:386 |
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| Enthalten in: |
The New England journal of medicine - 386(2022), 6 vom: 10. Feb., Seite 509-520 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Jayk Bernal, Angélica [VerfasserIn] |
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| Links: |
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| Themen: |
5CSZ8459RP |
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| Anmerkungen: |
Date Completed 21.02.2022 Date Revised 23.11.2023 published: Print-Electronic ClinicalTrials.gov: NCT04575597 CommentIn: N Engl J Med. 2022 Feb 10;386(6):592-593. - PMID 34914869 Citation Status MEDLINE |
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| doi: |
10.1056/NEJMoa2116044 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 500 | |a ClinicalTrials.gov: NCT04575597 | ||
| 500 | |a CommentIn: N Engl J Med. 2022 Feb 10;386(6):592-593. - PMID 34914869 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 Massachusetts Medical Society. | ||
| 520 | |a BACKGROUND: New treatments are needed to reduce the risk of progression of coronavirus disease 2019 (Covid-19). Molnupiravir is an oral, small-molecule antiviral prodrug that is active against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | ||
| 520 | |a METHODS: We conducted a phase 3, double-blind, randomized, placebo-controlled trial to evaluate the efficacy and safety of treatment with molnupiravir started within 5 days after the onset of signs or symptoms in nonhospitalized, unvaccinated adults with mild-to-moderate, laboratory-confirmed Covid-19 and at least one risk factor for severe Covid-19 illness. Participants in the trial were randomly assigned to receive 800 mg of molnupiravir or placebo twice daily for 5 days. The primary efficacy end point was the incidence hospitalization or death at day 29; the incidence of adverse events was the primary safety end point. A planned interim analysis was performed when 50% of 1550 participants (target enrollment) had been followed through day 29 | ||
| 520 | |a RESULTS: A total of 1433 participants underwent randomization; 716 were assigned to receive molnupiravir and 717 to receive placebo. With the exception of an imbalance in sex, baseline characteristics were similar in the two groups. The superiority of molnupiravir was demonstrated at the interim analysis; the risk of hospitalization for any cause or death through day 29 was lower with molnupiravir (28 of 385 participants [7.3%]) than with placebo (53 of 377 [14.1%]) (difference, -6.8 percentage points; 95% confidence interval [CI], -11.3 to -2.4; P = 0.001). In the analysis of all participants who had undergone randomization, the percentage of participants who were hospitalized or died through day 29 was lower in the molnupiravir group than in the placebo group (6.8% [48 of 709] vs. 9.7% [68 of 699]; difference, -3.0 percentage points; 95% CI, -5.9 to -0.1). Results of subgroup analyses were largely consistent with these overall results; in some subgroups, such as patients with evidence of previous SARS-CoV-2 infection, those with low baseline viral load, and those with diabetes, the point estimate for the difference favored placebo. One death was reported in the molnupiravir group and 9 were reported in the placebo group through day 29. Adverse events were reported in 216 of 710 participants (30.4%) in the molnupiravir group and 231 of 701 (33.0%) in the placebo group | ||
| 520 | |a CONCLUSIONS: Early treatment with molnupiravir reduced the risk of hospitalization or death in at-risk, unvaccinated adults with Covid-19. (Funded by Merck Sharp and Dohme; MOVe-OUT ClinicalTrials.gov number, NCT04575597.) | ||
| 650 | 4 | |a Clinical Trial, Phase III | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 7 | |a Antiviral Agents |2 NLM | |
| 650 | 7 | |a Hydroxylamines |2 NLM | |
| 650 | 7 | |a Cytidine |2 NLM | |
| 650 | 7 | |a 5CSZ8459RP |2 NLM | |
| 650 | 7 | |a molnupiravir |2 NLM | |
| 650 | 7 | |a YA84KI1VEW |2 NLM | |
| 700 | 1 | |a Gomes da Silva, Monica M |e verfasserin |4 aut | |
| 700 | 1 | |a Musungaie, Dany B |e verfasserin |4 aut | |
| 700 | 1 | |a Kovalchuk, Evgeniy |e verfasserin |4 aut | |
| 700 | 1 | |a Gonzalez, Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Delos Reyes, Virginia |e verfasserin |4 aut | |
| 700 | 1 | |a Martín-Quirós, Alejandro |e verfasserin |4 aut | |
| 700 | 1 | |a Caraco, Yoseph |e verfasserin |4 aut | |
| 700 | 1 | |a Williams-Diaz, Angela |e verfasserin |4 aut | |
| 700 | 1 | |a Brown, Michelle L |e verfasserin |4 aut | |
| 700 | 1 | |a Du, Jiejun |e verfasserin |4 aut | |
| 700 | 1 | |a Pedley, Alison |e verfasserin |4 aut | |
| 700 | 1 | |a Assaid, Christopher |e verfasserin |4 aut | |
| 700 | 1 | |a Strizki, Julie |e verfasserin |4 aut | |
| 700 | 1 | |a Grobler, Jay A |e verfasserin |4 aut | |
| 700 | 1 | |a Shamsuddin, Hala H |e verfasserin |4 aut | |
| 700 | 1 | |a Tipping, Robert |e verfasserin |4 aut | |
| 700 | 1 | |a Wan, Hong |e verfasserin |4 aut | |
| 700 | 1 | |a Paschke, Amanda |e verfasserin |4 aut | |
| 700 | 1 | |a Butterton, Joan R |e verfasserin |4 aut | |
| 700 | 1 | |a Johnson, Matthew G |e verfasserin |4 aut | |
| 700 | 1 | |a De Anda, Carisa |e verfasserin |4 aut | |
| 700 | 0 | |a MOVe-OUT Study Group |e verfasserin |4 aut | |
| 700 | 1 | |a Doreski, Pablo |e investigator |4 oth | |
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| 700 | 1 | |a Kallás, Ésper |e investigator |4 oth | |
| 700 | 1 | |a Gomes da Silva, Monica Maria |e investigator |4 oth | |
| 700 | 1 | |a Souto Lopes, Suzara |e investigator |4 oth | |
| 700 | 1 | |a Golin, Nicole Alberti |e investigator |4 oth | |
| 700 | 1 | |a Tytus, Richard |e investigator |4 oth | |
| 700 | 1 | |a Cruz, Germán |e investigator |4 oth | |
| 700 | 1 | |a Rodríguez, Ignacio |e investigator |4 oth | |
| 700 | 1 | |a Fernández, Plinio |e investigator |4 oth | |
| 700 | 1 | |a Elgueta, Sergio |e investigator |4 oth | |
| 700 | 1 | |a Perez, Carlos |e investigator |4 oth | |
| 700 | 1 | |a Moncada, Pablo Andres |e investigator |4 oth | |
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| 700 | 1 | |a Bautista, Leonardo |e investigator |4 oth | |
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| 700 | 1 | |a Accini, Jose |e investigator |4 oth | |
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| 700 | 1 | |a Zakharov, Konstantin |e investigator |4 oth | |
| 700 | 1 | |a Kostenko, Victor Avenirovich |e investigator |4 oth | |
| 700 | 1 | |a Tomaev, Uruzmag |e investigator |4 oth | |
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