Molnupiravir for early COVID-19 treatment in primary care: PANORAMIC platform trial

Problem

The pivotal MOVe-OUT trial (1) of the novel antiviral molnupiravir for COVID-19 documented reduced hospital admissions, but included mostly unvaccinated participants, in non-UK settings, and when the Omicron variant was not prevalent.

Approach

Participants were aged ≥50, or ≥18 years with major comorbidities, symptomatic for ≤5 days with confirmed COVID-19 in the community, randomised to usual care alone or plus molnupiravir (800mg bd for 5 days). Primary outcome: all-cause hospitalisation/death within 28 days. Secondary outcomes: recovery, health service contacts.

Findings

Between 8.12.21and 27.4.22, 25708 participants (mean age 56.6 years), were randomised to molnupiravir plus usual care (n=12744) or usual care alone (n=12934). Hospitalisation and deaths were similar in both groups: (105/12529 (0·8%) for molnupiravir and 98/12525 (0·8%) for usual care (posterior probability of superiority 0·33; adjusted odds ratio 1·06 (95% Bayesian credible interval [BCI]) 0·81 to 1·41). There was an estimated benefit of 4·2 (95% BCI: 3·8–4·6) days in time to first recovery with molnupiravir (posterior probability of superiority >0·999). In the molnupiravir group there were fewer consultations in primary care (respectively2425/12401(20%), 2876/12135(24%)), and on day 7 more had SARS-CoV-2 virus below detection levels (respectively 7/34 (21%) and 1/39 (3%); p=0.039). Further virology findings and the health economic analysis (in progress) will also be presented.

Consequences

Molnupiravir is not effective in reducing hospitalisations/deaths among higher risk, vaccinated adults with COVID-19 in the community, but improves recovery time, reduces viral load, and modestly reduced consultations in primary care. The cost-effectiveness of molnupiravir will a major consideration in determining whether it should be widely used in the NHS.