OBJECTIVE: This study aims to describe the outcomes of COVID-19 patients treated with molnupiravir and to explore the associations with various risk factors. METHODS: We conducted a single-centre, descriptive, retrospective study without a comparison group. RESULTS: Out of 141 patients, 70 (49.7%) required follow-up outpatient care. In the subgroup of 66 (46.8%) hospitalized patients, 28 (19.9%) developed interstitial viral pneumonia, with 6 (4.3%) deaths. Unvaccinated patients had a higher incidence of pneumonia (p = 0.020), and obesity was a significant risk factor for both pneumonia (p = 0.001) and mortality (p = 0.011). Patients over 60 years (p = 0.040) and those with cardiovascular diseases (p = 0.026) also had increased pneumonia risk. Male sex was associated with a higher risk of death (p = 0.020). CONCLUSION: Molnupiravir treatment was linked to reduced risks of hospitalization and death, particularly in high-risk patients. Vaccination provided additional protection, and obesity obstructive pulmonary disease and autoimmune diseases were significant risk factors for severe outcomes.

Department of Infectology and Travel Medicine Faculty of Medicine Pavol Jozef Safarik University in Kosice Kosice Slovak Republic

Department of Public Health and Hygiene Faculty of Medicine Pavol Jozef Safarik University in Kosice Kosice Slovak Republic

Department of Radiology AGEL Hospital Levoca Slovak Republic

See more in PubMed

Hu B, Guo H, Zhou P, Shi ZL. Characteristics of SARS-CoV-2 and COVID-19. Nat Rev Microbiol. 2021 Mar;19(3):141-54. PubMed DOI

Yuan Y, Jiao B, Qu L, Yang D, Liu R. The development of COVID-19 treatment. Front Immunol. 2023;14:1125246. doi: 10.3389/fimmu.2023.1125246. PubMed DOI

Maas BM, Strizki J, Miller RR, Kumar S, Brown M, Johnson MG, et al. Molnupiravir: mechanism of action, clinical, and translational science. Clin Transl Sci. 2024 Feb;17(2):e13732. doi: 10.1111/cts.13732. PubMed DOI

Jayk Bernal A, Gomes da Silva MM, Musungaie DB, Kovalchuk E, Gonzalez A, Delos Reyes V, et al. Molnupiravir for oral treatment of covid-19 in nonhospitalized patients. N Engl J Med. 2022 Feb 10;386(6):509-20. PubMed DOI

Butler CC, Hobbs FDR, Gbinigie OA, Rahman NM, Hayward G, Richards DB, et al. Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial. Lancet. 2023 Jan 28;401(10373):281-93. DOI

U. S. Food and Drug Administration. Fact sheet for healthcare providers: emergency use authorization for LAGEVRIO™ (molnupiravir) capsules [Internet]. White Oak: FDA; 2023 [cited 2024 Nov 29]. Available from: https://www.fda.gov/media/155054/download.

Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary. Am J Respir Crit Care Med. 2017;195(5):557-82. PubMed DOI

Kabinger F, Stiller C, Schmitzová J, Dienemann C, Kokic G, Hillen HS, et al. Mechanism of molnupiravir-induced SARS-CoV-2 mutagenesis. Nat Struct Mol Biol. 2021;28:740-6. PubMed DOI

Vicenti I, Zazzi M, Saladini F. SARS-CoV-2 RNA-dependent RNA polymerase as a therapeutic target for COVID-19. Expert Opin Ther Pat. 2021;31(4):325-37. PubMed DOI

Paymode DJ, Vasudevan N, Ahmad S, Kadam AL, Cardoso FSP, Burns JM, et al. Toward a practical, two-step process for molnupiravir: direct hydroxamination of cytidine followed by selective esterification. Org Process Res Dev. 2021;25(8):1822-30. DOI

Fischer W, Eron JJ, Holman W, Cohen MS, Fang L, Szewczyk LJ, et al. Molnupiravir, an oral antiviral treatment for COVID-19. medRxiv [Preprint]. 2021 Jun 17:2021.06.17.21258639. doi: 10.1101/2021.06.17.21258639. PubMed DOI

Caraco Y, Crofoot GE, Moncada PA, Galustyan AN, Musungaie DB, Payne B, et al. Phase 2/3 trial of molnupiravir for treatment of covid-19 in nonhospitalized adults. NEJM Evid. 2022 Feb;1(2):EVIDoa2100043. doi: 10.1056/EVIDoa2100043. PubMed DOI

Suzuki Y, Shibata Y, Minemura H, Nikaido T, Tanino Y, Fukuhara A, et al. Real-world clinical outcomes of treatment with molnupiravir for patients with mild-to-moderate coronavirus disease 2019 during the Omicron variant pandemic. Clin Exp Med. 2023 Oct;23(6):2715-23. PubMed DOI

Wong CKH, Au ICH, Lau KTK, Cowling BJ, Leung GM. Real-world effectiveness of early molnupiravir or nirmatrelvir-ritonavir in hospitalised patients with COVID-19 without supplemental oxygen requirement on admission during Hong Kong's omicron BA.2 wave: a retrospective cohort study. Lancet Infect Dis. 2022 Dec;22(12):1681-93. PubMed DOI

Xie Y, Bowe B, Al-Aly Z. Molnupiravir and risk of hospital admission or death in adults with COVID-19: emulation of a randomized target trial using electronic health records. BMJ. 2023 Mar 7:380:e072705. doi: 10.1136/bmj-2022-072705. PubMed DOI

Sawadogo W, Tsegaye M, Gizaw A, Adera T. Overweight and obesity as risk factors for COVID-19-associated hospitalisations and death: systematic review and meta-analysis. BMJ Nutr Prev Health. 2022;5(1):10-8. PubMed DOI

Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity. 2020;28(7):1195-9. PubMed DOI

Tamara A, Tahapary DL. Obesity as a predictor for a poor prognosis of COVID-19: a systematic review. Diabetes Metab Syndr. 2020 Jul-Aug;14(4):655-9. PubMed DOI

Silverio A, Di Maio M, Citro R, Esposito L, Iuliano G, Bellino M, et al. Cardiovascular risk factors and mortality in hospitalized patients with COVID-19: systematic review and meta-analysis of 45 studies and 18,300 patients. BMC Cardiovasc Disord. 2021 Jan 7;21(1):23. doi: 10.1186/s12872-020-01816-3. PubMed DOI

Cheng SL, Wang PH, Chang CY, Wang HH, Wang CJ, Chiu KM. The benefits of molnupiravir treatment in healthcare facilities patients with COVID-19. Drug Des Devel Ther. 2023 Jan 19;17:87-92. PubMed DOI

Arbel R, Wolff Sagy Y, Battat E, Lavie G, Sergienko R, Friger M, et al. Molnupiravir use and severe COVID-19 outcomes during the omicron surge. Res Sq [Preprint]. 2022 Sep 29:rs.3.rs-2115769. doi: 10.21203/rs.3.rs-2115769/v1. DOI

Weil C, Bergroth T, Eisenberg A, Whiteside YO, Caraco Y, Tene L, et al. Real-world utilization of molnupiravir during the COVID-19 omicron surge in Israel. Epidemiologia. 2023;4(3):309-21. PubMed DOI

Kimata M, Watanabe A, Yanagida Y, Kinoshita D, Maekawa S. Safety and effectiveness of molnupiravir (LAGEVRIO®) capsules in Japanese patients with COVID-19: interim report of post-marketing surveillance in Japan. Infect Dis Ther. 2023 Apr;12(4):1119-36. PubMed DOI

Ohashi H, Hishiki T, Akazawa D, Kim KS, Woo J, Shionoya K, et al. Different efficacies of neutralizing antibodies and antiviral drugs on SARS-CoV-2 Omicron subvariants, BA.1 and BA.2. Antiviral Res. 2022 Sep;205:105372. doi: 10.1016/j.antiviral.2022.105372. PubMed DOI

Rosenke K, Okumura A, Lewis MC, Feldmann F, Meade-White K, Bohler WF, et al. Molnupiravir (MK-4482) is efficacious against Omicron and other SARS-CoV-2 variants in the Syrian hamster COVID-19 model. bioRxiv [Preprint]. 2022 Feb 23:2022.02.22.481491. doi: 10.1101/2022.02.22.481491. PubMed DOI