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5MinuteConsult Journal Club

Molnupiravir Oral COVID-19 Treatment


Study Summary

This was the non-published, non-peer-reviewed press release of a phase III Merck randomized clinical trial on the oral COVID-19 anti-viral called Molnupiravir. It was studied in those who had non-hospitalized adult mild-moderate COVID-19 and were considered high risk (obese, Diabetes, older age, CV disease) who have NOT had the vaccine.

Their interim findings showed molnupiravir reduced the risk of hospitalization or death; 7.3% of those who received Molnupiravir were either hospitalized or died through day 29 following randomization vs 14.1% of placebo-treated patients; p=0.0012. Through Day 29, no deaths were reported in patients who received molnupiravir, vs. 8 deaths in patients who received placebo.


Molnupiravir may be an alternative treatment to monoclonal antibodies for those infected with COVID-19 who are at high risk for a severe outcome or death.


Merck claims Molnupiravir works by incorporating into the viral RNA and inducing mutations, altering viral replication. No safety data was released, just the outcome of reduced severe illness or death. The trial is not available to be read, and it has not been published or peer reviewed. Nonetheless, Merck is in the process of submitting for FDA Emergency Use Authorization.

For those who are vaccine hesitant because of worries about genetic alterations, they should be reminded that this pill, if it works, is going to alter genetic replication (of the virus). And, that it is an anti-viral, which traditionally have very high NNT. Thus, they should just get the vaccine.

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Coronavirus Disease 2019 (COVID-19)

Contributed by Frank J. Domino, MD, October 6, 2021