PANORAMIC trial finds molnupiravir does not reduce COVID-19 hospitalisation/deaths in vaccinated people at high risk

Researchers from the University of Oxford have today released findings from a clinical trial funded by the National Institute for Health and Care Research (NIHR) investigating the effectiveness of the antiviral treatment molnupiravir against COVID-19 – the first treatment tested in the ongoing PANORAMIC trial.

In their paper published in The Lancet, they reported that molnupiravir did not reduce hospitalisations or deaths among higher risk, vaccinated adults with COVID-19 in the community. The treatment was, however, associated with a faster recovery time and reduced viral detection and load. Participants who received molnupiravir reported feeling better compared to those who received usual care.

Molnupiravir (brand name Lagevrio) was the first treatment to be studied by the Platform Adaptive trial of NOvel antiviRals for eArly treatMent of COVID-19 In the Community (PANORAMIC), set up to identify which groups of higher risk people were most likely to benefit from new antiviral treatments for COVID-19. The study allows multiple antiviral drugs to be tested in parallel.

Earlier this year, GP practices across the North East and North Cumbria region were commended for their significant contributions to the study, having recruited particularly high numbers of participants to the molnupiravir arm of the trial.

Dr Yusuf Soni, Principal Investigator for the PANORAMIC trial at Hartlepool and Stockton Health Ltd, said: “These are important findings in our ongoing efforts to understand and treat COVID-19 and I am very proud to be part of the national effort to tackle the virus. Our staff have pulled out all the stops to deliver the PANORAMIC trial quickly and with maximum efficiency and we also couldn't have done it without the great support we have had from NIHR staff. The trial is a fantastic testament to what primary care research can achieve when we all work together. Congratulations to everybody involved.”

Professor Caroline Wroe, Clinical Director of the NIHR Clinical Research Network North East and North Cumbria, said: “PANORAMIC is the UK’s fastest ever recruiting interventional trial in primary care. It has succeeded in providing clear, timely evidence for patients and doctors that will inform treatment in the future. I am proud of the role that the North East and North Cumbria continues to play in the delivery of this vital study; a huge thank you to all the staff and participants who have made it possible.”

Chris Butler, Professor of Primary Care in the Nuffield Department of Primary Care Health Sciences and co-Chief Investigator of PANORAMIC, said: “Finding effective, safe and scalable early treatments for COVID-19 in the community is the next major frontier in our research response to the ongoing worldwide pandemic. It is in the community where treatments could have a massive reach and impact. But decisions about who to treat should always be based on evidence from rigorous clinical trials that involve people who would most likely be prescribed the drugs.

“The evidence PANORAMIC has produced about molnupiravir will guide treatment decisions for COVID-19 world-wide. It is rapidly generating critically important clinical evidence from within the pandemic to guide care during the pandemic itself, in this case determining effects of molnupiravir among people who are almost all vaccinated.

“We must not forget the other ongoing pandemic of antibiotic resistance, which in part stems from using antimicrobial drugs at scale before we did rigorous clinical trials to find out who really benefits from treatment, and who does not. The PANORAMIC team is also doing the necessary trials and gathering evidence about these treatments before we go straight to widespread use.”

People who had tested positive for COVID-19 within the past five days, and who were either aged over 50 years, or between 18-50 with underlying health conditions have been invited to take part in the study. A total of 25,786 study participants were randomly assigned to receive either molnupiravir or the usual standard of NHS care.

Recruitment of people from ethnically and culturally diverse backgrounds into clinical trials has been important in ensuring audiences likely to benefit from treatment are represented.

Professor Mahendra G Patel OBE, PANORAMIC’s Pharmacy, and Diversity, and Inclusivity Lead, said: “We are determined to ensure that we are as inclusive as possible in our recruitment. To this effect, we have been working closely with national and local communities and religious organisations, alongside national and regional pharmacy networks to help make the PANORAMIC trial more visible and easily accessible to as many people as possible, including from ethnically diverse communities.

“I’m delighted to see how our recruitment strategy has been hugely successful across all ethnicities and areas of high deprivation. This is an incredible testament to all those involved for their efforts in supporting the fastest and largest recruiting randomised interventional clinical trial in the world.”

PANORAMIC is led by the University of Oxford and funded by UK Research and Innovation (UKRI) and National Institute for Health and Care Research (NIHR).

The study will now continue to investigate new antiviral medications such as Paxlovid. For more information or to enrol, please visit www.panoramictrial.org.