Virology and Safety profile of Molnupiravir at three different doses: A systematic review and Meta-analysis

Molnupiravir (also known as EIDD-2801/MK-4482), which is used as an antiviral drug has its mechanism of action by incorporating into the viral genome increasing errors, mismatching, and misdirecting the viral polymerase, leading to the accumulation of deleterious errors and halting viral RNA replication of SARS-CoV-2 and other RNA viruses. Our meta-analysis aims to evaluate virology profile, and adverse effects associated with the use of molnupiravir on a large patient population. Following PRISMA guidelines performed a thorough literature search of electronic and medical databases (MEDLINE and Cochrane CENTRAL) from their establishment to January 2023 without any limitations on time, language, or sample size. The random effects model was utilized to calculate the weighted mean difference (WMD) and its associated 95% confidence intervals (CIs) to pool continuous outcomes of interest. Using a random effects model, odds ratio, and accompanying 95% confidence intervals (CIs). Molnupiravir 800 mg at day 5 is significant in creating viral RNA error rate (WMD: 4.91; 95% CI; [1.19, 8.63] p=0.01; I =0%). (P-value for subgroup differences = 0.05). A significant outcome was reported with 400mg molnupiravir (WMD: 2.27; 95% CI; 2.27 [0.50, 4.65] p=0.02; I =0%). Significant outcome for mean change in SARS-COV-2 RNA viral load from baseline in nasopharyngeal sample at 800 mg molnupiravir on day 3 (WMD: -0.22; 95% CI; [-0.35,-0.08] p=0.002; I =0%), day 5 (WMD: -0.32; 95% CI; [-0.53,-0.11] p=0.003; I =24%) and overall pooled analysis (WMD: -0.17; 95% CI; [-0.29, 0.33] p=0.003; I =32%). Similarly for 400 mg at DAY 5 and overall analysis comparing the molnupiravir group to the placebo group, a significant reduction in viral RNA load was seen from baseline. (WMD: -0.46; 95% CI; [-0.77,-0.15] p=0.004; I =0%), (WMD: -0.28; 95% CI; [-0.49,-0.07] p=0.009; I =0%). Molnupiravir 400mg significantly reduced the incidence of death as compared to the placebo group. (RR: 0.17; 95% CI; [0.07, 0.43] p=0.0002; I =0%). In our meta-analysis, we conclude that molnupiravir is effective in treating SARS-COV-2 patients with respect to eliminating the virus from the host through their mechanism of action. Thereby, widely used and appropriate to treat SARS-COV-2.