What is the use of Lagevrio (Molnupiravir)?

From the Guidelines

Lagevrio (molnupiravir) should be considered for the treatment of symptomatic patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 days of the onset of symptoms and at a high risk for progressing to severe disease, as supported by the American College of Physicians (1).

Key Points

• The standard dosage of Lagevrio is 800 mg (four 200 mg capsules) taken orally every 12 hours for 5 days.
• Lagevrio works by introducing errors into the viral RNA during replication, preventing the virus from multiplying properly.
• It is not recommended for use during pregnancy due to potential fetal harm, and sexually active individuals of reproductive potential should use effective contraception during and for 4 days (females) or 3 months (males) after treatment.
• Common side effects include diarrhea, nausea, and dizziness.
• Lagevrio is less effective than other COVID-19 treatments like Paxlovid and should be considered when other options are unavailable.

Considerations

• The use of Lagevrio should be based on individual patient risk factors and the availability of other treatment options.
• Vaccination remains essential for COVID-19 prevention and Lagevrio does not replace vaccination.
• The American College of Physicians recommends considering Lagevrio for treatment of COVID-19 in outpatient settings, as stated in their living, rapid practice points (1).

From the Research

Overview of Lagevrio (Molnupiravir)

• Lagevrio, also known as molnupiravir, is an antiviral medication used to treat mild to moderate COVID-19 in adults who are at risk for progression to severe illness 2, 3, 4.
• It works by targeting the viral polymerase and causing lethal mutations within the virus during replication, thereby inhibiting the virus's ability to reproduce 2, 3.

Efficacy and Safety of Molnupiravir

• Studies have shown that molnupiravir significantly reduces the risk of hospitalization and death in patients with COVID-19, with adjusted relative risk reductions of 30% 2.
• However, molnupiravir should not be used in children or pregnant persons due to concerns about potential toxicity, and reliable contraception should be used in persons of childbearing potential 2, 3.
• Adverse events have been reported in patients taking molnupiravir, although the frequency and severity of these events vary depending on the study 5, 6.

Comparison with Other Antiviral Medications

• Molnupiravir has been compared to other antiviral medications, such as nirmatrelvir/ritonavir and remdesivir, in terms of efficacy and safety 5, 6.
• Nirmatrelvir/ritonavir has been shown to have a greater risk reduction in hospitalization and death compared to molnupiravir, although both medications have been found to be effective in reducing the risk of severe outcomes 2, 3, 6.
• Remdesivir has been found to have no effect on risk of death, but may reduce hospital admissions, although the certainty of evidence is low 6.

Real-World Experience with Molnupiravir

• A real-world study conducted in Italy found that molnupiravir, nirmatrelvir/ritonavir, and remdesivir were effective in reducing the risk of hospitalization and death in patients with COVID-19, although the study found no difference in outcomes among the three medications 5.
• Another study found that nirmatrelvir/ritonavir was associated with a higher probability of having a negative test within 10 days from the first positive test, although adverse events occurred more frequently in the nirmatrelvir/ritonavir group 5.