This comprehensive Cochrane review analyzed 11 randomized trials involving over 31,000 participants to evaluate the effectiveness of molnupiravir for confirmed mild to moderate COVID-19. Across outpatient studies, molnupiravir showed little to no impact on all-cause mortality, hospitalization, or symptom resolution at 14 or 28 days, with only a clinically insignificant absolute mortality reduction. Early viral clearance was higher at day 5, but this advantage diminished by days 10–15 and did not translate into meaningful clinical improvement. Safety outcomes were comparable to placebo or usual care, with no significant increase in adverse or serious adverse events.
Evidence for hospitalized patients remained inconclusive due to substantial heterogeneity and limited data. The review notes that variations in vaccination status, risk of bias in several trials, and numerous unpublished studies may affect confidence in the results. Overall, molnupiravir appears to offer minimal clinical benefit in outpatients with mild to moderate COVID-19 and lacks evidence of benefit in inpatients, underscoring the need for further high-quality research, particularly in hospitalized populations.
Keywords: molnupiravir, COVID-19 treatment, viral clearance, randomized controlled trials