Published: 12 September 2024
New research has found that molnupiravir offers modest longer term benefits to vaccinated adults.
This is the latest outcome of the NIHR funded and delivered PANORAMIC trial, led by the University of Oxford.
Published this week in The Lancet Infectious Diseases, the new study builds on the earlier findings from the PANORAMIC trial. Molnupiravir was previously shown to shorten the acute illness episode by around four days. However, it did not significantly reduce hospitalisation or deaths in those aged 50 or older, or over 18 with underlying health conditions. Most of those in the group had received at least one dose of a COVID-19 vaccine.
The findings show that patients treated with the five-day course of the antiviral drug experienced modest benefits. There was a slight improvement in certain COVID-19 symptoms three and six months after infection. However, there was no significant difference in COVID-19 hospitalisations over the longer term.
Molnupiravir treatment outcomes after six months
Researchers followed up over 23,000 participants from the original PANORAMIC study. They compared the use of molnupiravir with usual care against usual care alone.
After both three and six months, molnupiravir recipients reported:
- slightly higher wellness scores;
- fewer severe symptoms such as fatigue and shortness of breath;
- less use of medications to treat their symptoms
- and better health-related quality of life.
The likelihood of reporting any persistent symptoms at 6 months reduced from 11% with usual care to 8.5% with molnupiravir. This provides a risk reduction of just 2.5%.
Assessing the impact on patient care
To assess the clinical impact researchers used a common measure called ‘number needed to treat’. It calculates the average number of patients who need a treatment to prevent one additional negative outcome. It can help decipher whether a new treatment makes a significant difference, when balanced with the cost of the treatment.
Molnupiravir is a relatively expensive drug – about £500 per course. So giving it to everyone who gets COVID-19 would be a significant cost for the NHS.
Important information for policy makers
Prof Phil Evans, Deputy Health and Care Director, NIHR Research Delivery Network Coordinating Centre said:
“These latest findings from the award-winning PANORAMIC study will help policy makers make decisions about the use of antivirals in the treatment of COVID-19.
“PANORAMIC continues to produce important results that will inform the treatment of COVID-19 in many countries across the world.
“We are enormously grateful to the many thousands of patients who volunteered to take part in this landmark study - and to those GP practices right across the country that helped to deliver it.”
Chris Butler, Professor of Primary Care in the Nuffield Department of Primary Care Health Sciences and co-Chief Investigator of PANORAMIC, summarised the new study, saying:
“Many people (and the healthcare professionals responsible for their treatment) wonder whether treating acute COVID-19 with a specific novel antiviral drug will reduce their
chances of suffering the long-term effects of COVID-19. For the first time, we have evidence from a well-conducted large scale randomised controlled trial that answers this question.
“The absolute differences at three and six months between participants receiving molnupiravir and those receiving usual care were small which means that large numbers of
patients would need to be treated with these expensive drugs to achieve relatively small benefits. These findings will be critically important to commissioners of care to inform care guidelines and decision making about the use of these novel agents.”
This latest study follows a recent NIHR paper that set out key learnings from the delivery of the PANORAMIC study about future pandemic preparedness.