Effectiveness of Molnupiravir for the Treatment of COVID-19: A Systematic Literature Review of Real-World Observational Studies

Molnupiravir (MOV), an oral antiviral, is prescribed to treat adult patients with mild-to-moderate COVID-19 at risk of progressing to severe disease. This systematic literature review assessed the real-world effectiveness of MOV for reducing the progression to severe COVID-19 outcomes in clinical settings, including high-risk or special populations (type 2 diabetes, chronic respiratory diseases, immunocompromised conditions, older adults, and nursing home residents). Studies comparing MOV-treated with untreated groups of non-hospitalized adults at risk of progression to severe COVID-19 outcomes (hospitalization, death, and the composite of hospitalization/death) were identified from EMBASE and PubMed (January 1, 2021‒May 24, 2024). Twenty-one general and special population studies were included. General population studies (n=16) showed that MOV reduced the risk of death, hospitalization, and hospitalization/death. Special population studies (n=10; five additional and five general population articles with subgroups of interest) also showed that MOV reduced the risk of the same outcomes, with a more pronounced effect in older adults (≥60 years). The wide range of risk reduction observed might be attributed to variability in COVID-19 hospitalization guidelines and vaccination coverage. Findings support the effectiveness of MOV in reducing the risk of hospitalization, death, and hospitalization/death compared with untreated groups, including high-risk adults with underlying comorbidities.