The aim: This study looked at whether molnupiravir, an antiviral treatment for COVID-19-infected patients at home, is good value for the NHS during the 6 months after patients get COVID-19.

The study: Study participants were randomly chosen to receive either molnupiravir or usual NHS care. Participants were within five days of symptom onset and were either aged 50 or over, OR aged 18 or over with underlying health conditions that made them more to likely have severe COVID-19 or experience complications. Most of the participants had been vaccinated for COVID-19 before taking part in the study. Data was collected for six months during the trial.

The results:

• People who took molnupiravir cost the NHS more to treat. Those who took molnupiravir had only slightly better health benefits than those on usual care treatment for COVID-19.
• Those who took Molnupiravir also took less time off work than those on usual care treatment.
• Therefore, molnupiravir is not likely to be good value for the NHS to give to all patients.
• However, looking at different patient subgroups, such as by age and ethnicity, molnupiravir could be good value if offered to people aged 75 and above, including people from Black, Asian and minority ethnic backgrounds. This is because the group who received molnupiravir had fewer hospital visits (which are expensive for the NHS) in the 4 weeks after starting the medication and research shows that those from these groups are more likely to be admitted to hospital if they contract COVID-19.
• For molnupiravir to offer good value to the NHS for treating a wider range of patients in the community with COVID-19, it would need to cost one third of its current price.

Research paper:  Click here to read the full paper

Cost-utility analysis of molnupiravir plus usual care versus usual care alone as early treatment for community-based adults with COVID-19 and increased risk of adverse outcomes in the UK PANORAMIC trial. British Journal of General Practice, 16 January 2024; BJGP.2023.0444. DOI: 10.3399/BJGP.2023.0444

The aim: Molnupiravir is an antiviral medication for the treatment of COVID-19. This study looked at how the medication affected the virus within the body and the body’s immune response to the virus.

The study: Participants were randomly chosen to receive either molnupiravir or usual NHS care. Study participants were within five days of experiencing symptoms and were aged 50 or over, OR aged 18 or over with underlying health conditions that made them more likely to have severe COVID-19 or experience complications. Nose swabs and blood sample were collected for 14 days. A total of 577 participants were included in the analysis.

The results:

• During the 5-day treatment period, molnupiravir reduced the amount of virus in the body faster than in those who did not take the medication.
• However, after the 5-day treatment ended the virus continued to be seen in some people and contained more variations of the virus when compared to participants who received usual care arm.
• Some of these variations of the viruses from patients who took the antiviral could be grown in the laboratory. This suggests they could still infect other people which might also allow the virus to keep spreading.
• The amount of antibodies (which help the body fight off the same type of virus in the future) in the blood increased at the start of infection for all participants, but after 2 weeks they were lower in those who took the molnupiravir compared to those who didn’t. More research is needed into how this might affect patients.

Research paper: Click here to read the full paper

Randomized controlled trial of molnupiravir SARS-CoV-2 viral and antibody response in at-risk adult outpatients. Nat Commun 15, 1652 (2024). https://doi.org/10.1038/s41467-024-45641-0 

The aim: The study looked at whether patients at home being treated with molnupiravir, an antiviral treatment for COVID-19, felt better and needed less healthcare support 3 and 6 months after first becoming ill.

The study: Participants were randomly chosen to receive either molnupiravir or usual NHS care. Participants were within the first five days of having COVID-19 symptoms and were aged 50 or over, OR aged 18 or over with underlying health conditions that made them more likely to have severe COVID-19 or experience complications. Most of the participants had been vaccinated for COVID-19 before taking part in the study. A total of 23, 008 participants took part in the study.

The results:

• Participants taking molnupiravir had less severe and persistent symptoms and better quality of life (reported by the participant on a scale of 0 being the worst health you can imagine and 100 being the best you can imagine), needed fewer healthcare services, and had less time away from work, study or their usual activities for 6 months after their COVID-19 infection. However these differences  were relatively small. To illustrate this, 53 people would need to take molnupiravir, for one person to experience a benefit by having less severe symptoms 6 months later.

• There was no difference in hospitalisations between those who took molnupiravir and those who didn't

• For the small number of participant who saw a longer lasting health benefit when taking molnupiravir at home, the risks (such as a possible effect on immunity to a subsequent COVID-19 infection) will also need to be considered carefully before prescribing molnupiravir to prevent long- term COVID-19 illness.

Research paper: Click here to read the full paper

Health outcomes 3 months and 6 months after molnupiravir treatment for COVID-19 for people at higher risk in the community (PANORAMIC): a randomised controlled trial. The Lancet Infections Diseases. 9 September 2024. https://doi.org/10.1016/S1473-3099(24)00431-6

Paxlovid

We are still collecting follow-up data for the Paxlovid arm. Please check back for proposed publications and dates.

Please also see our two year celebratory articles here: Celebrating Two Years of the PANORAMIC Trial: A Journey of Discovery, Diversity, and Innovation