Molnupiravir versus favipiravir in at-risk outpatients with COVID-19: A randomized controlled trial in Thailand
Issued Date
2024-06-01
Resource Type
ISSN
12019712
eISSN
18783511
Scopus ID
2-s2.0-85190801581
Pubmed ID
38561040
Journal Title
International Journal of Infectious Diseases
Volume
143
Rights Holder(s)
SCOPUS
Bibliographic Citation
International Journal of Infectious Diseases Vol.143 (2024)
Suggested Citation
Salvadori N., Jourdain G., Krittayaphong R., Siripongboonsitti T., Kongsaengdao S., Atipornwanich K., Sakulkonkij P., Angkasekwinai N., Sirijatuphat R., Chusri S., Mekavuthikul T., Apisarnthanarak A., Srichatrapimuk S., Sungkanuparph S., Kirdlarp S., Phongnarudech T., Sangsawang S., Napinkul P., Achalapong J., Khusuwan S., Pratipanawat P., Nookeu P., Danpipat N., Leethong P., Hanvoravongchai P., Sukrakanchana P.o., Auewarakul P. Molnupiravir versus favipiravir in at-risk outpatients with COVID-19: A randomized controlled trial in Thailand. International Journal of Infectious Diseases Vol.143 (2024). doi:10.1016/j.ijid.2024.107021 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/98151
Title
Molnupiravir versus favipiravir in at-risk outpatients with COVID-19: A randomized controlled trial in Thailand
Author(s)
Salvadori N.
Jourdain G.
Krittayaphong R.
Siripongboonsitti T.
Kongsaengdao S.
Atipornwanich K.
Sakulkonkij P.
Angkasekwinai N.
Sirijatuphat R.
Chusri S.
Mekavuthikul T.
Apisarnthanarak A.
Srichatrapimuk S.
Sungkanuparph S.
Kirdlarp S.
Phongnarudech T.
Sangsawang S.
Napinkul P.
Achalapong J.
Khusuwan S.
Pratipanawat P.
Nookeu P.
Danpipat N.
Leethong P.
Hanvoravongchai P.
Sukrakanchana P.o.
Auewarakul P.
Jourdain G.
Krittayaphong R.
Siripongboonsitti T.
Kongsaengdao S.
Atipornwanich K.
Sakulkonkij P.
Angkasekwinai N.
Sirijatuphat R.
Chusri S.
Mekavuthikul T.
Apisarnthanarak A.
Srichatrapimuk S.
Sungkanuparph S.
Kirdlarp S.
Phongnarudech T.
Sangsawang S.
Napinkul P.
Achalapong J.
Khusuwan S.
Pratipanawat P.
Nookeu P.
Danpipat N.
Leethong P.
Hanvoravongchai P.
Sukrakanchana P.o.
Auewarakul P.
Author's Affiliation
Siriraj Hospital
Samutsakhon General Hospital
National Health Foundation, Thailand
Thammasat University Hospital
Lampang Hospital
Faculty of Medicine, Prince of Songkla University
Chulabhorn Royal Academy
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Rajavithi Hospital
Chiang Mai University
Kalasin Hospital
Health Promotion Center Region 10
Mahasarakham Hospital
Chiangrai Prachanukroh Hospital
Samutprakarn Hospital
Samutsakhon General Hospital
National Health Foundation, Thailand
Thammasat University Hospital
Lampang Hospital
Faculty of Medicine, Prince of Songkla University
Chulabhorn Royal Academy
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Rajavithi Hospital
Chiang Mai University
Kalasin Hospital
Health Promotion Center Region 10
Mahasarakham Hospital
Chiangrai Prachanukroh Hospital
Samutprakarn Hospital
Corresponding Author(s)
Other Contributor(s)
Abstract
Objectives: Evaluate and compare the efficacy and safety of molnupiravir and favipiravir in outpatients with mild to moderate COVID-19 and at risk of severe COVID-19. Methods: In an open-label, parallel-group, multicenter trial in Thailand, participants with moderate COVID-19 and at least one factor associated with severe COVID-19 were randomly assigned 1:1 to receive oral molnupiravir or oral favipiravir (standard of care). Phone calls for remote symptom assessment were made on Days 6, 15, and 29. Participants with worsening symptoms were instructed to return to the hospital. The primary endpoint was pulmonary involvement by Day 29, as evidenced by ≥2 of the following: dyspnea, oxygen saturation <92% or imaging. Results: Nine hundred seventy-seven participants (487 molnupiravir, 490 favipiravir) were enrolled from 8 July 2022 to 19 January 2023. 98% had received ≥1 dose of COVID-19 vaccine and 83% ≥3 doses. By Day 29, pulmonary involvement occurred in 0% (0/483) in molnupiravir arm versus 1% (5/482) in favipiravir arm (−1.0%; Newcombe 95.2% CI: −2.4% to −0.0%; P = 0.021); all-cause death in 0% (0/483) and <1% (1/482); COVID-19 related hospitalization in <1% (1/483) and 1% (3/482); treatment-related adverse event in 1% (5/483) and 1% (4/486); and serious adverse event in 1% (4/483) and 1% (4/486). Conclusions: Favipiravir and molnupiravir had a similar efficacy and safety profile. Whether either of the two reduced the risk of complications during the omicron era in this population with a low risk of pulmonary involvement and a high vaccine coverage remains unclear. There were no differences in any of the safety endpoints. Thai Clinical Trials Registry ID: TCTR20230111009.