The first antiviral approved to treat Covid-19, molnupiravir, does not reduce hospital admissions or deaths in vaccinated adults with Covid-19 infection who are at increased risk of mortality, according to the results of a randomized controlled trial published in The Lancet. .
However, patients treated at home with molnupiravir recovered faster than the control group.
Preliminary data from the study, conducted in the winter of 2021-2022 when the Omicron variant was dominant, were released in October. As a result, doctors are already considering limiting the use of molnupiravirFor example, in Australia.
Previous studies showed that molnupiravir, developed by MSD -known as Merck in the United States and Canada- and Ridgeback Biotherapeutics, is effective in reducing hospital admissions in patients with mild to moderate Covid-19 and the World Health Organization (WHO) recommends its use for patients with the highest risk of hospital admission.
The manufacturer of molnupiravir assured that the antiviral reduced the risk of hospitalization or death of patients with this disease by around 50%. In addition, this drug had two great advantages: pthey hated to be taken orallywhich allowed their prescription and administration outside the hospital, and their large-scale synthesis was simple, so that, initially, there would be no major limitations to access them.
However, until now studies have only been carried out in populations that were largely unvaccinated and before the appearance of the omicron variant. This new trial was conducted in a largely vaccinated population where the majority of Covid-19 infections had been caused by omicron.
“Although this trial has found no benefit of molnupiravir treatment in its primary outcome, which hypothesized that molnupiravir treatment for vaccinated and at-risk patients would reduce the likelihood of hospitalization or death, it suggests that this treatment might have other benefits. such as faster recovery time.” says lead author Chris Butler of the University of Oxford (UK).
The study, PANORAMIC, compared the oral pill with standard treatment only in people older than 50 years or older than 18 years with underlying conditions. They had not felt well with confirmed Covid for five days or less in the community setting.
Using antivirals to treat patients who are unlikely to benefit carries the risk of further driving antimicrobial resistance
When molnupiravir was originally tested, it was found to be 30% effective in reducing hospitalizations, but that was in unvaccinated patients.
These results demonstrate that the vaccine’s protection is so strong that there is no clear benefit from the drug in terms of further reducing hospitalizations and deaths, study co-author Jonathan Van-Tam of the University of New York told Reuters. Nottingham.
“As countries move forward with their strategies to manage successive waves of Covid-19 infections, the issue of antibiotic resistance must not be forgotten. Using antivirals to treat patients who are unlikely to benefit carries the risk of further driving antimicrobial resistance, wasting resources, and exposing people to unnecessary harm. Thus, our study contributes to the valuable evidence base on who should not be treated with these precious newly discovered agents, to empower clinicians to make evidence-based decisions when prescribing treatments for Covid-19 infections», warns Ly-Mee Yufrom the University of Oxford.
However, the drug was effective in lowering the viral load and can help speed a patient’s recovery by about four days, the researchers estimated based on the study data.
«There may be circumstances where molnupiravir could be useful, for example in healthcare systems under stress where it could be used to help key workers get back to work faster.says study co-lead researcher Chris Butler of the University of Oxford.
But ultimately, those benefits need to be weighed against the cost of the drug, adds researcher Paul Little of the University of Southampton.
“For now, I think it’s fair to say don’t use this drug in the general population, including those at slightly increased risk,” Little concludes.