Comparing the Effectiveness and Safety of Remdesivir and Molnupiravir in COVID-19: A Systematic Review and Meta-Analysis.

BACKGROUND

Remdesivir and molnupiravir have been approved and are being used as viable treatment options for patients with coronavirus disease 2019 (COVID-19). This systematic review and meta-analysis sought to evaluate and compare the safety and effectiveness of these two antiviral drugs in the treatment of COVID-19.

METHODS

An extensive search was conducted across several databases, including Web of Science, PubMed, the Cochrane Library, and medRxiv, up to July 1, 2024. To evaluate the risk of bias, a standardized bias assessment tool was used. Data from the selected studies were analyzed using Comprehensive Meta-Analysis software.

RESULTS

The analysis included data from 10 studies, encompassing a total of 5766 patients. According to the meta-analysis, remdesivir and molnupiravir showed no statistically significant differences in mortality (odds ratio [OR] = 2.54, 95% confidence interval [CI]: 0.67, 9.57), hospitalizations (OR = 2.43, 95% CI: 0.81, 7.24), viral clearance rates (OR = 1.49, 95% CI: 0.64, 3.46), or average time to viral clearance (standardized mean difference = 0.02, 95% CI: -0.40, 0.46). However, the incidence of adverse events was lower in the remdesivir group (OR = 0.49, 95% CI: 0.26, 0.93). The certainty of evidence for these findings was evaluated and determined to be low or moderate.

CONCLUSION

The findings of this study suggest that remdesivir and molnupiravir have similar effectiveness in treating COVID-19 outpatients; however, molnupiravir is associated with a higher rate of adverse events. Additional studies are required to enable a more thorough evaluation of these treatments for COVID-19.