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0 0.5 1 1.5 2+ Mortality 60% Improvement Relative Risk Death/hospitalization -6% primary Hospitalization -9% Transmission 3% Sustained recovery 22% Recovery time 19% First recovery 30% Recovery time (b) 26% Viral load, day 14 -13% Viral load, day 7 20% Viral load, day 5 17% Butler et al. ISRCTN30448031 PANORAMIC Molnupiravir RCT EARLY Favors molnupiravir Favors control
Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): preliminary analysis from the United Kingdom randomised, controlled open-label, platform adaptive trial
Butler et al., SSRN (Preprint), PANORAMIC, ISRCTN30448031
6 Oct 2022    Source   PDF   Share   Tweet
25,000 patient RCT in the UK, showing faster recovery but no significant difference in hospitalization/death or transmission. Improved recovery may in part be due to placebo effect in this open label trial with self-reported symptomatic data. Viral load initially declined more quickly, but was higher at 14 days.
Concerns have been raised that the mutagenic mechanism of action may create dangerous variants or cause cancer [Hadj Hassine, Swanstrom]. See [] for analysis of a variant potentially created by molnupiravir.
risk of death, 60.1% lower, RR 0.40, p = 0.29, treatment 2 of 12,516 (0.0%), control 5 of 12,484 (0.0%), NNT 4154, day 28.
risk of death/hospitalization, 6.0% higher, RR 1.06, p = 0.34, treatment 103 of 12,516 (0.8%), control 96 of 12,484 (0.8%), odds ratio converted to relative risk, day 28, primary outcome.
risk of hospitalization, 9.4% higher, RR 1.09, p = 0.57, treatment 102 of 12,516 (0.8%), control 93 of 12,484 (0.7%), day 28.
risk of transmission, 2.6% lower, RR 0.97, p = 0.90, treatment 3,890 of 10,823 (35.9%), control 3,874 of 10,557 (36.7%), NNT 133, odds ratio converted to relative risk.
risk of no sustained recovery, 21.9% lower, RR 0.78, p < 0.001, treatment 3,874 of 12,432 (31.2%), control 4,847 of 12,151 (39.9%), NNT 11.
recovery time, 19.4% lower, relative time 0.81, p < 0.001, treatment 12,432, control 12,151, inverted to make RR<1 favor treatment, sustained recovery.
risk of no first recovery, 30.3% lower, RR 0.70, p < 0.001, treatment 2,691 of 12,432 (21.6%), control 3,775 of 12,151 (31.1%), NNT 11.
recovery time, 26.5% lower, relative time 0.74, p < 0.001, treatment 12,432, control 12,151, inverted to make RR<1 favor treatment, first recovery.
viral load, 12.9% higher, relative load 1.13, p = 0.006, treatment mean 2.72 (±1.33) n=203, control mean 2.41 (±1.05) n=241, all samples, day 14.
viral load, 20.4% lower, relative load 0.80, p = 0.004, treatment mean 3.86 (±1.4) n=35, control mean 4.85 (±1.45) n=40, all samples, day 7.
viral load, 17.1% lower, relative load 0.83, p < 0.001, treatment mean 4.88 (±1.51) n=238, control mean 5.89 (±1.41) n=280, all samples, day 5.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Butler et al., 6 Oct 2022, Randomized Controlled Trial, United Kingdom, preprint, 54 authors, trial ISRCTN30448031 (PANORAMIC).
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