Bangkok, April 26, 2022 — For adults battling mild to moderate COVID-19, the antiviral drug molnupiravir appeared to lead to faster recovery than three days of intravenous remdesivir, according to a retrospective study conducted at King Chulalongkorn Memorial Hospital in Thailand. The findings, which could influence treatment decisions in resource-limited settings, suggest molnupiravir may be a viable option for those at risk of severe illness.
Molnupiravir vs. Remdesivir: A Real-World Look
The study compared outcomes for patients receiving either oral molnupiravir or IV remdesivir during the early stages of COVID-19.
- Researchers analyzed data from 182 patients treated in April 2022.
- Treatment failure occurred in 7.8% of the molnupiravir group versus 22.9% of the remdesivir group (P = 0.007).
- By day 10, a significantly higher proportion of patients in the molnupiravir group (39.0%) had clinically resolved compared to the remdesivir group (71.4%) (P < 0.001).
- Male gender and the presence of pneumonia were associated with treatment failure.
The initiation of antiviral treatment for COVID-19 hinges on a patient’s risk of developing severe symptoms. Molnupiravir and remdesivir represent newer antiviral options, but real-world data, particularly from regions like Thailand, has been limited until now.
Study Details and Findings
The retrospective study, conducted at King Chulalongkorn Memorial Hospital, Thai Red Cross Society, included 182 adult patients (18 years and over) diagnosed with mild to moderate COVID-19 during April 2022. Participants received either five days of oral molnupiravir or three days of intravenous remdesivir at the start of their treatment. Researchers analyzed factors associated with treatment failure using logistic regression, with statistical significance set at P < 0.05.
Of the 182 patients, 105 (57.7%) received remdesivir, while 77 (42.3%) received molnupiravir. A statistically significant difference in treatment failure rates was observed: 6 cases (7.8%) in the molnupiravir group and 24 cases (22.9%) in the remdesivir group (P = 0.007). Furthermore, by day 10, a greater percentage of patients in the molnupiravir group—30 patients (39.0%)—had clinically resolved compared to those in the remdesivir group—75 patients (71.4%) (P < 0.001).
The analysis revealed that male gender (adjusted odds ratio [aOR] = 3.375) and the presence of pneumonia (aOR = 2.495) were significantly associated with treatment failure. Importantly, no deaths or rehospitalizations within 30 days of antiviral therapy were reported during the study period.
Adverse Effects
Both antiviral agents were generally well-tolerated. Adverse drug reactions (ADRs) included headaches or dizziness in 3.8% of patients receiving remdesivir and diarrhea in 5.2% of those receiving molnupiravir.
What Does This Mean for COVID-19 Treatment?
What are the recommended treatments for mild to moderate COVID-19 patients at risk of severe illness? Molnupiravir and three-days intravenous remdesivir remain recommended treatment options. The study authors conclude that both antiviral agents are safe, with few and generally mild ADRs. They emphasize the importance of closely monitoring COVID-19 patients with pneumonia, as this condition was linked to treatment failure.
