Efficacy and safety of three new oral antiviral treatment (molnupiravir, fluvoxamine and Paxlovid) for COVID-19：a meta-analysis

Ann Med. 2022 Dec;54(1):516-523. doi: 10.1080/07853890.2022.2034936.

Abstract

Background: The coronavirus disease (COVID-19) epidemic has not been completely controlled. Although great achievements have been made in COVID-19 research and many antiviral drugs have shown good therapeutic effects against COVID-19, a simple oral antiviral drug for COVID-19 has not yet been developed. We conducted a meta-analysis to investigate the improvement in mortality or hospitalization rates and adverse events among COVID-19 patients with three new oral antivirals (including molnupiravir, fluvoxamine and Paxlovid).

Methods: We searched scientific and medical databases, such as PubMed, Web of Science, Embase and Cochrane Library for relevant articles and screened the references of retrieved studies on COVID-19.

Results: A total of eight studies were included in this study. The drug group included 2440 COVID-19 patients, including 54 patients who died or were hospitalized. The control group included a total of 2348 COVID-19 patients, including 118 patients who died or were hospitalized. The overall odds ratio (OR) of mortality or hospitalization was 0.33 (95% confidence interval [CI], 0.22-0.49) for COVID-19 patients in the drug group and placebo group, indicating that oral antiviral drugs were effective for COVID-19 patients and reduced the mortality or hospitalization by approximately 67%.

Conclusions: This study showed that three novel oral antivirals (molnupiravir, fluvoxamine and Paxlovid) are effective in reducing the mortality and hospitalization rates in patients with COVID-19. In addition, the three oral drugs did not increase the occurrence of adverse events, thus exhibiting good overall safety. These three oral antiviral drugs are still being studied, and the available data suggest that they will bring new hope for COVID-19 recovery and have the potential to be a breakthrough and very promising treatment for COVID-19.KEY MESSAGESMany antiviral drugs have shown good therapeutic effects, and there is no simple oral antiviral drug for COVID-19 patients.Meta-analysis was conducted for three new oral antivirals to evaluate the improvement in mortality or hospitalization rates and adverse events among COVID-19 patients.We focussed on three new oral Coronavirus agents (molnupiravir, fluvoxamine and Paxlovid) and hope to provide guidance for the roll-out of oral antivirals.

Keywords: COVID-19; Paxlovid™; fluvoxamine; molnupiravir.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antiviral Agents / adverse effects
  • COVID-19 Drug Treatment*
  • Cytidine / analogs & derivatives
  • Drug Combinations
  • Fluvoxamine* / adverse effects
  • Humans
  • Hydroxylamines
  • Lactams
  • Leucine
  • Nitriles
  • Proline
  • Ritonavir
  • SARS-CoV-2

Substances

  • Antiviral Agents
  • Drug Combinations
  • Hydroxylamines
  • Lactams
  • Nitriles
  • nirmatrelvir and ritonavir drug combination
  • Cytidine
  • Proline
  • Leucine
  • Ritonavir
  • Fluvoxamine
  • molnupiravir

Grants and funding

This study was supported by Hangzhou Science and Technology Bureau fund [No. 20191203B96; No. 20191203B105]; Youth Fund of Zhejiang Academy of Medical Sciences [No. 2019Y009]; Medical and Technology Project of Zhejiang Province [No. 2020362651, No. 2021KY890]; Clinical Research Fund of Zhejiang Medical Association [No. 2020ZYC-A13]; Hangzhou Health and Family Planning Technology Plan Key Projects [No. 2017ZD02]; Zhejiang Medical and Health Science and Technology Plan Project [No. 2019RC245]; Hangzhou Medical and Health Technology Project [No. 0020290592]; Hangzhou Agricultural and Social Development Research Active Design Project [No. 20190101A03]. Zhejiang Traditional Chinese Medicine Scientific Research Fund Project [No. 2022ZB280]. The work was supported by the Key medical disciplines of Hangzhou.