Evidence map›Paper›PMID 38396069›Full record

Trial reportNature communications2024

Randomized controlled trial of molnupiravir SARS-CoV-2 viral and antibody response in at-risk adult outpatients.

Joseph F Standing, Laura Buggiotti, Jose Afonso Guerra-Assuncao, Maximillian Woodall, Samuel Ellis, Akosua A Agyeman, Charles Miller, Mercy Okechukwu, Emily Kirkpatrick, Amy I Jacobs and 34 more

Open access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Nature communications, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
26citing papers in PubMed, 3 pooled it
15.2field-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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

26 citing papers in PubMed, 3 syntheses or guidelines pooled it, 39 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Trial
  5. Trial
  6. Trial
  7. Virologic Response and Safety of Ibuzatrelvir, A Novel SARS-CoV-2 Antiviral, in Adults With COVID-19.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025
    Trial
  8. Trial
  9. Review
  10. Article
  11. Observational
  12. Review
  13. Review
  14. Article
  15. Review
  16. Review
  17. Article
  18. Review
  19. Review
  20. EfficientAntimicrobial agents and chemotherapy · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

44 authors at 15 institutions in 3 countries.

Joseph F StandingInfection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK. j.standing@ucl.ac.uk.ORCID 0000-0002-4561-7173
Laura BuggiottiInfection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK.ORCID 0000-0002-7404-7800
Jose Afonso Guerra-AssuncaoInfection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK.
Maximillian WoodallInfection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK.
Samuel EllisInfection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK.
Akosua A AgyemanInfection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK.
Charles MillerGreat Ormond Street Hospital for Children NHS Trust, London, UK.
Mercy OkechukwuInfection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK.
Emily KirkpatrickInfection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK.
Amy I JacobsInfection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK.
Charlotte A WilliamsGenetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK.
Sunando RoyGenetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK.
Luz M Martin-BernalGenetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK.
Rachel WilliamsGenetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK.
Claire M SmithInfection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK.ORCID 0000-0002-8913-0009
Theo SandersonFrancis Crick Institute, London, UK.ORCID 0000-0003-4177-2851
Fiona B AshfordClinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.ORCID 0000-0002-2946-3864
Beena EmmanuelClinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
Zaheer M AfzalClinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
Adrian ShieldsClinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.ORCID 0000-0001-5345-2156
Alex G RichterClinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
Jienchi DorwardNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.ORCID 0000-0001-6072-1430
Oghenekome GbinigieNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Oliver Van HeckeNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Mark LownPrimary Care Research Centre, University of Southampton, Southampton, UK.
Nick FrancisPrimary Care Research Centre, University of Southampton, Southampton, UK.
Bhautesh JaniSchool of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Duncan B RichardsNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.ORCID 0000-0002-8093-7084
Najib M RahmanRespiratory Trials Unit and Oxford NIHR Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK.ORCID 0000-0003-1195-1680
Ly-Mee YuNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.ORCID 0000-0003-0331-7364
Nicholas P B ThomasWindrush Medical Practice, Witney, UK.
Nigel D HartSchool of Medicine, Dentistry and Biomedical Sciences. Queen's University Belfast, Belfast, UK.ORCID 0000-0002-8168-1746
Philip EvansAPEx (Exeter Collaboration for Academic Primary Care), University of Exeter Medical School, Exeter, UK.ORCID 0000-0002-5277-3545
Monique AnderssonRadcliffe Department of Medicine, University of Oxford, Oxford, UK.ORCID 0000-0003-0619-1074
Gail HaywardNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Kerenza HoodCentre for Trials Research, Cardiff University, Wales, UK.ORCID 0000-0002-5268-8631
Jonathan S Nguyen-Van-TamLifespan and Population Health, University of Nottingham School of Medicine, Nottingham, UK.ORCID 0000-0003-2579-4655
Paul LittlePrimary Care Research Centre, University of Southampton, Southampton, UK.
F D Richard HobbsNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Saye KhooDepartment of Pharmacology, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.ORCID 0000-0002-2769-0967
Christopher ButlerNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.ORCID 0000-0002-0102-3453
David M Lowe *Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, UK.ORCID 0000-0001-6102-2375
Judith Breuer *Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK.ORCID 0000-0001-8246-0534
PANORAMIC Virology Group
Great Ormond Street Hospital · GBUniversity of Oxford · GBUniversity of Birmingham · GBNIHR Southampton Biomedical Research Centre · GBCardiff University · GBCentre for the AIDS Programme of Research in South Africa · ZAIQVIA (United Kingdom) · GBNuffield Orthopaedic Centre · GBQueen's University Belfast · GBRoyal Free London NHS Foundation Trust · GBThe Francis Crick Institute · GBUniversity of Exeter · GBUniversity of Glasgow · GBUniversity of Liverpool · GBUniversity of Nottingham · GB

Funding

Marie Curie MCCC-RP-14-A17178Medical Research Council G0600475Medical Research Council G1001128Medical Research Council MR/M008665/1Medical Research Council MR/W015560/1Medical Research Council MR/X004724/1Wellcome Trust 210918/Z/18/Z
6 · The paper itself

Abstract

Viral clearance, antibody response and the mutagenic effect of molnupiravir has not been elucidated in at-risk populations. Non-hospitalised participants within 5 days of SARS-CoV-2 symptoms randomised to receive molnupiravir (n = 253) or Usual Care (n = 324) were recruited to study viral and antibody dynamics and the effect of molnupiravir on viral whole genome sequence from 1437 viral genomes. Molnupiravir accelerates viral load decline, but virus is detectable by Day 5 in most cases. At Day 14 (9 days post-treatment), molnupiravir is associated with significantly higher viral persistence and significantly lower anti-SARS-CoV-2 spike antibody titres compared to Usual Care. Serial sequencing reveals increased mutagenesis with molnupiravir treatment. Persistence of detectable viral RNA at Day 14 in the molnupiravir group is associated with higher transition mutations following treatment cessation. Viral viability at Day 14 is similar in both groups with post-molnupiravir treated samples cultured up to 9 days post cessation of treatment. The current 5-day molnupiravir course is too short. Longer courses should be tested to reduce the risk of potentially transmissible molnupiravir-mutated variants being generated. Trial registration: ISRCTN30448031.

Indexed as

COVID-19HydroxylaminesSARS-CoV-2AdultAntibodies, ViralAntibody FormationAntiviral AgentsCytidineHumansOutpatientsAntibodies, ViralAntiviral AgentsCytidineHydroxylaminesmolnupiravir

Identifiers

PMID38396069
PMCPMC10891158
OpenAlexW4392106105

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.