Molnupiravir got approval in December 2021, in many countries for use in adults from certain high-risk groups of severe COVID-19, based on positive results of the MOVeOUT trial published in the New England Journal of Medicine. Thus trial included unvaccinated adults with mild-to-moderate COVID-19 and at least one risk factor for severe COVID-19 illness, comprising: age >60 years, active cancer, chronic kidney disease, chronic obstructive pulmonary disease, obesity (BMI ≥30 kg/m2 ), major heart disease (heart failure, coronary artery disease, or cardiomyopathy), or diabetes mellitus. 

Will molnupiravir be a real game-changer in reducing hospital admissions and mortality depends on the properties of this agent, its effect on different SARS-CoV-2 variants and also on the effective system of its distribution promptly to those selected patients who potentially benefit the most. 

The final report on molnupiravir was described a greater chance for symptom improvement by days 10 and 15, when treated very early in the course of COVID-19, no later than 5 days from symptoms onset. Thus a very well established and easily accessible system of testing for SARS-CoV-2 infection in primary care and patient awareness for timely detection of COVID-19 is critical for the best effects of treatment. 

Thus the conceivable conclusion for the guideline developers is that reasonable selection of most vulnerable risk groups and forming strategies to ensure timely initiation of therapy in local practice, will cause a lower number needed to treat (NNT) and be more effective for the effort. It is also crucial to take into account the significant contraindication or precautions of these agents while developing recommendations and selecting patients which may benefit the most.

Source- Pol Arch Intern Med; 2022 Jan 03. doi:10.20452/pamw.16183