| Title: |
Molnupiravir versus placebo in unvaccinated and vaccinated patients with early SARS-CoV-2 infection in the UK (AGILE CST-2): a randomised, placebo-controlled, double-blind, phase 2 trial. |
| Authors: |
Khoo, Saye H; FitzGerald, Richard; Saunders, Geoffrey; Middleton, Calley; Ahmad, Shazaad; Edwards, Christopher J; Hadjiyiannakis, Dennis; Walker, Lauren; Lyon, Rebecca; Shaw, Victoria; Mozgunov, Pavel; Periselneris, Jimstan; Woods, Christie; Bullock, Katie; Hale, Colin; Reynolds, Helen; Downs, Nichola; Ewings, Sean; Buadi, Amanda; Cameron, David; Edwards, Thomas; Knox, Emma; Donovan-Banfield, I'ah; Greenhalf, William; Chiong, Justin; Lavelle-Langham, Lara; Jacobs, Michael; Northey, Josh; Painter, Wendy; Holman, Wayne; Lalloo, David G; Tetlow, Michelle; Hiscox, Julian A; Jaki, Thomas; Fletcher, Thomas; Griffiths, Gareth; AGILE CST-2 Study Group |
| Publisher Information: |
Elsevier; Department of Medicine; //doi.org/10.1016/s1473-3099(22)00644-2 |
| Publication Year: |
2022 |
| Collection: |
Apollo - University of Cambridge Repository |
| Subject Terms: |
Adolescent; Adult; Female; Humans; Male; Antiviral Agents; Bayes Theorem; COVID-19; COVID-19 Vaccines; Double-Blind Method; SARS-CoV-2; Treatment Outcome; United Kingdom; Cytidine; Hydroxylamines |
| Description: |
BACKGROUND: The antiviral drug molnupiravir was licensed for treating at-risk patients with COVID-19 on the basis of data from unvaccinated adults. We aimed to evaluate the safety and virological efficacy of molnupiravir in vaccinated and unvaccinated individuals with COVID-19. METHODS: This randomised, placebo-controlled, double-blind, phase 2 trial (AGILE CST-2) was done at five National Institute for Health and Care Research sites in the UK. Eligible participants were adult (aged ≥18 years) outpatients with PCR-confirmed, mild-to-moderate SARS-CoV-2 infection who were within 5 days of symptom onset. Using permuted blocks (block size 2 or 4) and stratifying by site, participants were randomly assigned (1:1) to receive either molnupiravir (orally; 800 mg twice daily for 5 days) plus standard of care or matching placebo plus standard of care. The primary outcome was the time from randomisation to SARS-CoV-2 PCR negativity on nasopharyngeal swabs and was analysed by use of a Bayesian Cox proportional hazards model for estimating the probability of a superior virological response (hazard ratio [HR]>1) for molnupiravir versus placebo. Our primary model used a two-point prior based on equal prior probabilities (50%) that the HR was 1·0 or 1·5. We defined a priori that if the probability of a HR of more than 1 was more than 80% molnupiravir would be recommended for further testing. The primary outcome was analysed in the intention-to-treat population and safety was analysed in the safety population, comprising participants who had received at least one dose of allocated treatment. This trial is registered in ClinicalTrials.gov, NCT04746183, and the ISRCTN registry, ISRCTN27106947, and is ongoing. FINDINGS: Between Nov 18, 2020, and March 16, 2022, 1723 patients were assessed for eligibility, of whom 180 were randomly assigned to receive either molnupiravir (n=90) or placebo (n=90) and were included in the intention-to-treat analysis. 103 (57%) of 180 participants were female and 77 (43%) were male and 90 (50%) ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
Print-Electronic; application/pdf |
| Language: |
English |
| Relation: |
https://www.repository.cam.ac.uk/handle/1810/344184 |
| DOI: |
10.17863/CAM.91608 |
| Availability: |
https://www.repository.cam.ac.uk/handle/1810/344184; https://doi.org/10.17863/CAM.91608 |
| Rights: |
Attribution 4.0 International ; https://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.6FADACD8 |
| Database: |
BASE |