Molnupiravir for treatment of adults with mild or moderate COVID-19: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: The effects of molnupiravir in treating patients with non-severe COVID-19 remain uncertain. OBJECTIVES: To evaluate the efficacy and safety of molnupiravir in adult patients with mild or moderate COVID-19. DATA SOURCES: PubMed, Embase, CENTRAL, Web of Science, and WHO COVID-19 database up to 27 December 2022. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials with no language restrictions. PARTICIPANTS: Adults with mild or moderate COVID-19. INTERVENTIONS: Molnupiravir against standard care or placebo. ASSESSMENT OF RISK OF BIAS: We used a revision of RoB-2 criteria. METHODS OF DATA SYNTHESIS: Outcomes were mortality, hospital admission, viral clearance, time to viral clearance, time to symptom resolution or clinical improvement, any adverse events, and serious adverse events. We performed DerSimonian-Laird random-effects meta-analyses to summarize the evidence and evaluated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: Nine randomized controlled trials enrolling 30 472 patients proved eligible. Majority of patients were outpatients, with a mean age ranging from 35 to 56.6 years. In adult patients with mild or moderate COVID-19, molnupiravir probably reduces mortality (relative risk [RR], 0.43; 95% CI, 0.20-0.94; risk difference [RD], 0.1% fewer; moderate certainty) and the risk of hospital admission (RR, 0.67; 95% CI, 0.45-0.99; RD, 1.4% fewer; moderate certainty) and may reduce time to viral clearance (mean difference, -1.81 days; 95% CI, -3.31 to -0.31; low certainty) and time to symptom resolution or clinical improvement (mean difference, -2.39 days; 95% CI, -3.71 to -1.07; low certainty). Molnupiravir probably increases the rate of viral clearance (RR, 3.47; 95% CI, 2.43-4.96; RD 16.1% more; moderate certainty) at 7 days (±3 days) and likely does not increase serious adverse events (RR, 0.84; 95% CI, 0.61-1.15; RD 0.1% fewer; moderate certainty). CONCLUSIONS: In adult patients with mild or moderate COVID-19, molnupiravir likely reduces mortality and risk of hospital admission probably without increasing serious adverse events.

Caution in underrepresentation of older adults in clinical trials on COVID-19 vaccines.

We read with great interest the article "Underrepresentation of older adults in clinical trials on COVID-19 vaccines: A systematic review" written by Nicola Veronese et al. This important work demonstrated that medications and vaccines commonly used in older adults have not been adequately evaluated. Concerning this systematic review, we shall like to mention some certain points deserved to be attended by the authors.