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Molnupiravir does not reduce COVID-19 hospitalisations or deaths in vaccinated, high risk people

Published: 23 December 2022

Molnupiravir does not reduce hospitalisations or deaths among higher risk, vaccinated adults with COVID-19, NIHR-funded research has found.

The treatment was associated with a faster recovery time and reduced viral detection and load. Participants receiving molnupiravir reported feeling better in comparison to those who received usual care.

Molnupiravir was the first treatment tested in the ongoing PANORAMIC trial, led by researchers at the University of Oxford.

The PANORAMIC trial was set up to discover new COVID-19 antiviral treatments and identify which groups of higher risk people were most likely to benefit from them. The nationwide study allows multiple antiviral drugs to be tested in parallel.

Chris Butler, Professor of Primary Care in the Nuffield Department of Primary Care Health Sciences and co-Chief Investigator of PANORAMIC, said: “Finding effective, safe and scalable early treatments for COVID-19 in the community is the next major frontier in our research response to the ongoing worldwide pandemic. It is in the community where treatments could have a massive reach and impact. But decisions about who to treat should always be based on evidence from rigorous clinical trials that involve people who would most likely be prescribed the drugs.

“The evidence PANORAMIC has produced about molnupiravir will guide treatment decisions for COVID-19 world-wide. It is rapidly generating critically important clinical evidence from within the pandemic to guide care during the pandemic itself, in this case determining effects of molnupiravir among people who are almost all vaccinated.

“We must not forget the other ongoing pandemic of antibiotic resistance, which in part stems from using antimicrobial drugs at scale before we did rigorous clinical trials to find out who really benefits form treatment, and who does not. The PANORAMIC team is also doing the necessary trials and gathering evidence about these treatments before we go straight to widespread use.”

Prof Nick Lemoine, Medical Director of the NIHR Clinical Research Network, said: “PANORAMIC is an important NIHR-funded trial that enabled the rapid production of evidence and information about how well this new antiviral works.

“The commendable pace and scale at which this study recruited in at-risk groups shows how we can adapt to make future trials more accessible to a more diverse group of people. It is also testament to the GPs and researchers involved in this trial that we were able to recruit so fast in such record numbers.”

Professor Lucy Chappell, Chief Executive of the NIHR, said: “Over twenty five thousand participants from across the UK have taken part in the PANORAMIC trial. This was a huge national effort, involving many different partners across the health and research sectors. “Those who have taken part in this research have played an important part in helping researchers gather the vital information needed to find new treatments to save and improve lives.”

Innovative recruitment methods were used to include as many people as possible, from diverse communities. A total of 25,786 study participants were randomly assigned to receive either molnupiravir or the usual standard of NHS care.

Study participants were:

  • within five days of symptoms onset and
  • either aged over 50 years in good health or
  • between 18-50 with underlying health conditions that made them clinically more vulnerable.

The findings show the majority of higher risk groups gained only symptomatic improvement with molnupiravir.

The study reinforces the ongoing importance of the COVID vaccination programme in reducing death and hospitalisation.

PANORAMIC is funded by UK Research and Innovation (UKRI) and NIHR. The study will continue to investigate new antiviral medications such as Paxlovid. For more information or to enrol, please visit the PANORAMIC website

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