INTRODUCTION
Coronavirus disease (COVID-19) which is defined as a severe acute respiratory syndrome caused by a coronavirus, and hence also known as SARS-CoV-2 has created a devastating situation, infecting 610 million people along with 6.5 million deaths worldwide. [1]
Since the virus has a rapidly mutating property, many new variants have emerged increasing infectivity and transmission. The Omicron variant that is currently dominating has a higher infectivity and strong vaccine breakthrough ability and among the three lineages (BA.1, BA.2, BA.3) of this variant, BA.2 has become a “variant of concern” increasing hospitalization. [2,3]
Although many patients recover without treatment, a significant number of patients infected with COVID-19 need hospitalization, especially the ones with pre-existing conditions such as diabetes mellitus, obesity, and cardiac conditions. Although the administration of vaccines and various techniques are effective in reducing the incidence of hospitalization and death, its coverage remains insufficient. [4,5,6]
The need for initiation of treatment is required at the earliest after the onset of symptoms, and therapies that can be easily administered by patients are needed since no therapies have been shown to eliminate the infectious virus and prevent transmission, oral antivirals are needed. There are two classes of antiviral drugs authorized for COVID-19 treatment; remdesivir and monoclonal antibodies. Remedesivir is approved by the FDA for the treatment of severe COVID-19 patients hospitalized. [7] Molnupiravir (also known as EIDD-2801/MK-4482), which is used as an antiviral drug is an orally administered, small molecule ribonucleoside prodrug of N-hydroxycytidine that is rapidly metabolized by esterases and absorbed into the system and acts by phosphorylating into NHC-triphosphate intracellularly, incorporating into the viral genome increasing errors, mismatch and misdirects the viral polymerase, leading to accumulation of deleterious errors and halting viral RNA replication of SARS-CoV-2 and other RNA viruses. [4,6,8]
In the first 5 days of infections, when the patient is characterized by an early peak viral load, any antiviral administered early can have the most effect on the infection. Molnupiravir has three doses for administration (200mg, 400mg, and 800mg) that significantly reduce viral titers and block transmission to uninfected people. Studies have shown that molnupiravir administered in PCR-positive patients in aforementioned doses twice daily for 5 days, was found negatively cultured in all the patients after administration of the drug compared to placebo. [8] Molnupiravir was found well tolerated and has a shred of strong evidence that it is not mutagenic or genotoxic in mammals even at exposure above therapeutic targets, however, it has several adverse effects which can be mild-severe. [6,9] Our meta-analysis aims to evaluate virology profile, and adverse effects associated with the use of molnupiravir on a large patient population.