Rachel Fieldhouse MOLNUPIRAVIR may cut the

38 % and 14 % reduced risk of post-acute death and hospital

Paul Griffin said it was clear the drug still had an impor-

researchers compared 180- day outcomes between 11,500

risk of long COVID symptoms

admission , respectively .

tant role .

patients treated with mol-

as well as post-acute death

In absolute terms , the risk

“ We know these antivi-

nupiravir within five days of

regardless of a patient ’ s vac-

reduction at 180 days was

rals have an effect in the acute

testing positive to SARS-CoV-2

cination status or prior infec-

between 0.9 % and 3 % across

phase , and new evidence sug-

and 218,000 controls without

tion , epidemiologists report .

the three main outcomes , the

gests there is an impact in the

treatment .

Their US study of nearly

researchers said .

longer-term manifestations as

The majority of the male

230,000 veterans with COVID-

Although Australian

well ,” he said .

cohort ( mean age 69 ) had at

19 suggests the antiviral is

guidelines advised against the

“ If we look at the burden

least one risk factor for severe

associated with a 14 % lower

routine use of molnupiravir

of long COVID , minimising

COVID-19 and were excluded

Associate Professor Paul Griffin .

relative risk of post-acute sequelae versus no treatment .

It was also linked to a

( Lagevrio ) in those with mild COVID-19 , infectious diseases physician Associate Professor

that in any way could be quite significant .”

As part of the study ,

if they used other COVID-19 antivirals or antibodies within 30 days of infection .

In addition to the main

findings , molnupiravir

reduced the risk of eight out

of 13 prespecified long COVID

conditions : dysrhythmia , pulmonary

embolism , DVT , liver

disease , acute kidney disease ,

fatigue and malaise , muscle

pain and neurocognitive

impairment .

But no such benefits were

seen for rates of incident

ischaemic heart disease , diabetes

, dyspnoea , cough and

dysautonomia .

“ These findings suggest

that treatment with molnupiravir

in the acute phase

of SARS-CoV-2 infection may

be a viable strategy to reduce

the risk of post-acute adverse

health outcomes ,” the authors

concluded .

Writing in The BMJ , they

added that the results aligned

with their previous study ,

showing similar benefits with

nirmatrelvir – ritonavir ( Paxlovid

), including a 26 % lower

risk of long COVID symptoms .

“ The clinical decision to

use antivirals during acute

SARS-CoV-2 infection should

consider the effectiveness of

antivirals in reducing the burden

of death and disease in

both the acute and the postacute

phases of COVID-19 ,”

they said .

The study was limited by

5

the chosen population , but Professor Griffin — who was

not involved in the research

— said this did not undermine

the results .

“ A better-designed study

would look across a number

of different databases in different

countries with different

populations , but the feasibility

of that is probably prohibitive

,” said the University of

Queensland researcher .

Even so , the reduction in

risk would still “ likely contribute

to some very significant

outcomes ”.

“ People are very critical

of this trial because the impact is not as great as

another oral antiviral drug

we have , … but I think [ they ]

have lost sight of the limitations

or contraindications of

[ nirmatrelvir – ritonavir ].

“ We should not abandon

offering molnupiravir

as a second option because

its benefits are becoming

increasingly clear .”

BMJ 2023 ; 14 Mar .