Further to the recent National COVID-19 Clinical Evidence Taskforce published recommendation for molnupiravir (Lagevrio) in at-risk unvaccinated patients with mild COVID-19, the Taskforce has made a further consensus recommendation for its use in partially vaccinated patients.

Consensus recommendation:

In addition to at-risk unvaccinated adults, also consider using molnupiravir within five days of symptom onset in adults with COVID-19 who do not require oxygen and:

• are immunosuppressed or not immunocompetent regardless of vaccination status; or

• have received one or two doses of vaccine and who are at high risk of severe disease on the basis of age and multiple risk factors

AND where other treatments (such as sotrovimab or nirmatrelvir plus ritonavir) are not suitable or available.

Available research does not currently provide enough evidence to determine the benefits of molnupiravir in specific subgroups of patients. In the absence of definitive evidence, the Taskforce has arrived at a consensus recommendation based on their combined clinical expertise to guide clinical decisions about which patients are most likely to benefit from molnupiravir.

There is no evidence evaluating the effectiveness of molnupiravir in partially or fully vaccinated patients. Given this, and the lower risk of deterioration in these patients, it is unlikely that molnupiravir will have a significant treatment benefit in patients who have received three doses of vaccine, unless the patient is immunosuppressed.

There is limited evidence on the effectiveness of molnupiravir in immunosuppressed patients. However, given the likely higher risk of deterioration in these patients, and the absence of reasons to believe otherwise, it is likely that molnupiravir will be beneficial for immunosuppressed patients.

The remark accompanying the recommendation defines immunocompromising conditions.

Molnupiravir is now being considered by our special population panels to determine whether additional specific recommendations are needed for these groups.

National COVID-19 Clinical Evidence Taskforce