Molnupiravir Recommended for Patients with Non-Severe COVID-19 at Highest Risk of Hospital Admission

Molnupiravir can help prevent more severe COVID-19 symptoms developing if it is used as early as possible after infection.

The World Health Organization Guideline Development Group of International Experts has recommended molnupiravir, an antiviral drug, for patients with non-severe COVID-19 who have a high risk of hospitalization.

Although patients with the highest risk of hospitalization typically include those who are unvaccinated, older people, and those with weak immune systems or chronic diseases, the panel recommends that young and healthy patients, including children and pregnant/breastfeeding women, should not be given the drug due to potential harms.

Molnupiravir is an antiviral medicine that works by stopping COVID-19 from spreading, and it can help prevent more severe symptoms developing if it is used as early as possible after infection.

The recommendation is based on new data from 6 randomized controlled trials involving 4796 patients, which is the largest dataset on this drug so far, according to the panel.

Evidence from existing trials suggests that molnupiravir reduces the risk of hospital admission (43 fewer admissions per 1000 patients at highest risk) and time to symptom resolution (which was on average 3.4 fewer days), whereas low certainty evidence suggests a small effect on mortality, which was 6 fewer deaths per 1000 patients.

Certain mitigation strategies were described by the panel that are needed at population level, such as pharmacovigilance and antiviral resistance monitoring, given concerns about genotoxicity, emergence of resistance, and new variants.

However, there were no recommendations for patients with severe or critical illness since there are no trial data on molnupiravir for this population. Cost and availability issues associated with molnupiravir were also highlighted by the panel, which may make access to low- and middle- income countries challenging and exacerbate health inequity.

Further, in the same guidance update, the panel recommended a treatment combining 2 antibodies, casirivimab and imdevimab, to be used in people who are confirmed not to have the omicron variant.

The new guidance adds to previous recommendations for the use of baricitinib, interleukin-6 receptor blockers and systemic corticosteroids for patients with severe or critical COVID-19.


WHO recommends antiviral drug for patients with non-severe COVID-19 at highest risk of hospital admission. EurekAlert! March 2, 2022. Accessed March 10, 2022.

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