背景:莫努比拉韦治疗非重症COVID-19患者的效果仍不确定。
目的:评价莫努比拉韦治疗成人轻中度COVID-19的疗效和安全性。
方法:PubMed,Embase,中部,WebofScience,和世卫组织COVID-19数据库截至2022年12月27日。
方法:没有语言限制的随机对照试验(RCT)。
方法:成人轻度或中度COVID-19。
方法:Molnupiravir反对标准治疗或安慰剂。
■我们使用了RoB-2标准的修订版。
■结果是死亡率,入院,病毒清除,病毒清除时间,症状缓解或临床改善的时间,任何不良事件,和严重不良事件。我们进行了DerSimonian-Laird随机效应荟萃分析,以总结证据并使用GRADE方法评估证据的确定性。
结果:9个RCTs招募了30,472名患者,证明符合条件。大多数病人是门诊病人,平均年龄从35岁到56.6岁。在患有轻度或中度COVID-19的成年患者中,莫那普拉韦可能会降低死亡率(相对风险(RR)0.43,95%CI0.20至0.94,风险差异(RD)减少0.1%;中度确定性)和入院风险(RR0.67,95%CI0.45至0.99,RD减少1.4%;中度确定性),并可能减少病毒清除时间(MD-1.81天,95%CI-3.31至-0.31;低确定性)和症状缓解或临床改善的时间(MD-2.39天,95%CI-3.71至-1.07;低确定性)。Molnupiravir可能会增加7天(±3天)的病毒清除率(RR3.47,95%CI2.43至4.96,RD16.1%以上;中度确定性),并且可能不会增加严重不良事件(RR0.84,95%CI0.61至1.15,RD减少0.1%;中度确定性)。
结论:在患有轻度或中度COVID-19的成年患者中,莫那普拉韦可能会降低死亡率和住院风险,而不会增加严重不良事件。
BACKGROUND: The effects of
molnupiravir in treating patients with non-severe COVID-19 remain uncertain.
OBJECTIVE: To evaluate the efficacy and safety of
molnupiravir in adult patients with mild or moderate COVID-19.
METHODS: PubMed, Embase, CENTRAL, Web of Science, and WHO COVID-19 database up to 27 December 2022.
METHODS: Randomized controlled trials with no language restrictions.
METHODS: Adults with mild or moderate COVID-19.
METHODS: Molnupiravir against standard care or placebo.
UNASSIGNED: We used a revision of RoB-2 criteria.
UNASSIGNED: Outcomes were mortality, hospital admission, viral clearance, time to viral clearance, time to symptom resolution or clinical improvement, any adverse events, and serious adverse events. We performed DerSimonian-Laird random-effects meta-analyses to summarize the evidence and evaluated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.
RESULTS: Nine randomized controlled trials enrolling 30 472 patients proved eligible. Majority of patients were outpatients, with a mean age ranging from 35 to 56.6 years. In adult patients with mild or moderate COVID-19,
molnupiravir probably reduces mortality (relative risk [RR], 0.43; 95% CI, 0.20-0.94; risk difference [RD], 0.1% fewer; moderate certainty) and the risk of hospital admission (RR, 0.67; 95% CI, 0.45-0.99; RD, 1.4% fewer; moderate certainty) and may reduce time to viral clearance (mean difference, -1.81 days; 95% CI, -3.31 to -0.31; low certainty) and time to symptom resolution or clinical improvement (mean difference, -2.39 days; 95% CI, -3.71 to -1.07; low certainty). Molnupiravir probably increases the rate of viral clearance (RR, 3.47; 95% CI, 2.43-4.96; RD 16.1% more; moderate certainty) at 7 days (±3 days) and likely does not increase serious adverse events (RR, 0.84; 95% CI, 0.61-1.15; RD 0.1% fewer; moderate certainty).
CONCLUSIONS: In adult patients with mild or moderate COVID-19,
molnupiravir likely reduces mortality and risk of hospital admission probably without increasing serious adverse events.