Evidence map›Paper›PMID 36566761›Full record

Trial reportLancet (London, England)2023

Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial.

Christopher C Butler, F D Richard Hobbs, Oghenekome A Gbinigie, Najib M Rahman, Gail Hayward, Duncan B Richards, Jienchi Dorward, David M Lowe, Joseph F Standing, Judith Breuer and 48 more

2 registry-linked trialsOpen access · hybridAbstract readRandomized Controlled TrialMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Lancet (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 222 papers, 16 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
222citing papers in PubMed, 16 pooled it
38.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06917001 phase2not yet recruitingnot on this mapstarted 2026, after this paper: background citation

A Randomized, Double-blind, Placebo-controled, Phase 2a Trial Evaluating the Safety and Initial Efficacy of Resomelagon in Patients With Dengue Infection

TypeinterventionalSponsorFederal University of Minas GeraisRan2026 to 2027Enrolled120ConditionsDengue FeverArmsResomelagon, Placebo, Standard Treatment
NCT07583992 phase2not yet recruitingnot on this mapstarted 2026, after this paper: background citation

Multicenter Phase II Trial of NRICM102 Combined With Standard Therapy in Pneumonia

TypeinterventionalSponsorNational Research Institute of Chinese Medicine, Ministry of Health and WelfareRan2026 to 2027Enrolled150ConditionsMild to Moderate, Community-Acquired Pneumonia (CAP), Antibiotic Therapy, IntravenousArmsNRICM102, Placebo, Intravenous Antibiotic
3 · Its place in the literature

Who cites it

222 citing papers in PubMed, 16 syntheses or guidelines pooled it, 395 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Pooled it
  11. Pooled it
  12. Pooled it
  13. Pooled it
  14. Molnupiravir for treatment of adults with mild or moderate COVID-19: a systematic review and meta-analysis of randomized controlled trials.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2023
    Pooled it
  15. Pooled it
  16. Pooled it
  17. Trial
  18. Trial
  19. Trial
  20. Trial

162 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

58 authors at 16 institutions in 4 countries.

Christopher C ButlerNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. Electronic address: christopher.butler@phc.ox.ac.uk.
F D Richard HobbsNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Oghenekome A GbinigieNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Najib M RahmanOxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, UK; Oxford National Institute for Health and Care Research Biomedical Research Centre, Oxford, UK.
Gail HaywardNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Duncan B RichardsNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Jienchi DorwardNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
David M LoweInstitute of Immunity and Transplantation, University College London, London, UK.
Joseph F StandingInfection, Inflammation and Immunology, UCL Great Ormond Street Institute of Child Health, London, UK; Department of Pharmacy, Great Ormond Street Hospital for Children, London, UK.
Judith BreuerInfection, Inflammation and Immunology, UCL Great Ormond Street Institute of Child Health, London, UK.
Saye KhooDepartment of Pharmacology, University of Liverpool, Liverpool, UK.
Stavros PetrouNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Kerenza HoodCentre for Trials Research, Cardiff University, Cardiff, UK.
Jonathan S Nguyen-Van-TamLifespan and Population Health Unit, University of Nottingham School of Medicine, Nottingham, UK.
Mahendra G PatelNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Benjamin R SavilleBerry Consultants, Austin, TX, USA; Department of Biostatistics, Vanderbilt School of Medicine, Nashville, TN, USA.
Joe MarionBerry Consultants, Austin, TX, USA.
Emma OgburnNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Julie AllenNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Heather RutterNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Nick FrancisPrimary Care Research Centre, University of Southampton, Southampton, UK.
Nicholas P B ThomasWindrush Medical Practice, Witney, UK; National Institute for Health and Care Research Clinical Research Network: Thames Valley and South Midlands, Oxford, UK; Royal College of General Practitioners, London, UK.
Philip EvansFaculty of Health and Life Sciences, University of Exeter, Exeter, UK; National Institute for Health and Care Research Clinical Research Network, Leeds, UK.
Melissa DobsonOxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Tracie-Ann MaddenCentre for Trials Research, Cardiff University, Cardiff, UK.
Jane HolmesNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Victoria HarrisNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
May Ee PngNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Mark LownPrimary Care Research Centre, University of Southampton, Southampton, UK.
Oliver van HeckeNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Michelle A DetryBerry Consultants, Austin, TX, USA.
Christina T SaundersBerry Consultants, Austin, TX, USA.
Mark FitzgeraldBerry Consultants, Austin, TX, USA.
Nicholas S BerryBerry Consultants, Austin, TX, USA.
Lazaro MwandighaNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Ushma GalalNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Sam MortNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Bhautesh D JaniGeneral Practice and Primary Care, School of Health and Wellbeing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.
Nigel D HartSchool of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
Haroon AhmedDivision of Population Medicine, Cardiff University, Cardiff, UK.
Daniel ButlerSchool of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
Micheal McKennaNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Jem ChalkNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Layla LavalleeNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Elizabeth HadleyNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Lucy CuretonNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Magdalena BenysekNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Monique AnderssonDepartment of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Maria CoatesNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Sarah BarrettNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Clare BatemanNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Jennifer C DaviesNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Ivy Raymundo-WoodNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Andrew Ustianowskiand Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester, UK.
Andrew Carson-StevensDivision of Population Medicine, Cardiff University, Cardiff, UK.
Ly-Mee YuNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Paul LittlePrimary Care Research Centre, University of Southampton, Southampton, UK.
PANORAMIC Trial Collaborative Group
University of Oxford · GBBerry & Associates (United States) · USCardiff University · GBQueen's University Belfast · GBUniversity of Southampton · GBUniversity College London · GBGreat Ormond Street Hospital · GBUniversity of Nottingham · GBNIHR Research Delivery Network · GBNIHR Southampton Biomedical Research Centre · GBNorth Manchester General Hospital · GBNuffield Orthopaedic Centre · GBOxford University Hospitals NHS Trust · GBUniversity of Exeter · GBUniversity of Glasgow · GBUniversity of Liverpool · GB

Funding

Medical Research Council G1001128Medical Research Council MC_UU_00004/04Medical Research Council MR/M008665/1Medical Research Council MR/W015560/1Wellcome Trust
6 · The paper itself

Abstract

backgroundThe safety, effectiveness, and cost-effectiveness of molnupiravir, an oral antiviral medication for SARS-CoV-2, has not been established in vaccinated patients in the community at increased risk of morbidity and mortality from COVID-19. We aimed to establish whether the addition of molnupiravir to usual care reduced hospital admissions and deaths associated with COVID-19 in this population.

methodsPANORAMIC was a UK-based, national, multicentre, open-label, multigroup, prospective, platform adaptive randomised controlled trial. Eligible participants were aged 50 years or older-or aged 18 years or older with relevant comorbidities-and had been unwell with confirmed COVID-19 for 5 days or fewer in the community. Participants were randomly assigned (1:1) to receive 800 mg molnupiravir twice daily for 5 days plus usual care or usual care only. A secure, web-based system (Spinnaker) was used for randomisation, which was stratified by age (<50 years vs ≥50 years) and vaccination status (yes vs no). COVID-19 outcomes were tracked via a self-completed online daily diary for 28 days after randomisation. The primary outcome was all-cause hospitalisation or death within 28 days of randomisation, which was analysed using Bayesian models in all eligible participants who were randomly assigned. This trial is registered with ISRCTN, number 30448031.

findingsBetween Dec 8, 2021, and April 27, 2022, 26 411 participants were randomly assigned, 12 821 to molnupiravir plus usual care, 12 962 to usual care alone, and 628 to other treatment groups (which will be reported separately). 12 529 participants from the molnupiravir plus usual care group, and 12 525 from the usual care group were included in the primary analysis population. The mean age of the population was 56·6 years (SD 12·6), and 24 290 (94%) of 25 708 participants had had at least three doses of a SARS-CoV-2 vaccine. Hospitalisations or deaths were recorded in 105 (1%) of 12 529 participants in the molnupiravir plus usual care group versus 98 (1%) of 12 525 in the usual care group (adjusted odds ratio 1·06 [95% Bayesian credible interval 0·81-1·41]; probability of superiority 0·33). There was no evidence of treatment interaction between subgroups. Serious adverse events were recorded for 50 (0·4%) of 12 774 participants in the molnupiravir plus usual care group and for 45 (0·3%) of 12 934 in the usual care group. None of these events were judged to be related to molnupiravir.

interpretationMolnupiravir did not reduce the frequency of COVID-19-associated hospitalisations or death among high-risk vaccinated adults in the community.

fundingUK National Institute for Health and Care Research.

Indexed as

COVID-19AdultBayes TheoremCOVID-19 VaccinesCytidineHumansHydroxylaminesMiddle AgedProspective StudiesSARS-CoV-2Treatment OutcomeCOVID-19 VaccinesCytidineHydroxylaminesmolnupiravir

Identifiers

PMID36566761
PMCPMC9779781
OpenAlexW4312134853

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.