Molnupiravir is recommended as an option for treating mild to moderate COVID‑19 in adults who have a positive SARS‑CoV‑2 test, only if:
they have 1 or more risk factors for progression to severe COVID‑19 (as defined in section 5 of NICE's technology appraisal guidance on nirmatrelvir plus ritonavir and tocilizumab for treating COVID-19) and
nirmatrelvir plus ritonavir is contraindicated or unsuitable.
Usual treatment for mild to moderate COVID‑19 in people at risk of developing severe COVID‑19 includes nirmatrelvir plus ritonavir. There are no other treatment options when this medicine cannot be used.
The company asked for molnupiravir to be considered only in the community setting for people with mild to moderate COVID‑19 who are at risk of developing severe COVID‑19 and cannot have nirmatrelvir plus ritonavir. This does not include everyone it is licensed for.
Some results from clinical trials and real-world evidence for the people molnupiravir is licensed for suggest that it reduces the likelihood of hospitalisation or death compared with no treatment.
Molnupiravir is cost effective for people who are immunocompromised. There is a substantial overlap between these people and those with risk factors defined in section 5 of NICE's technology appraisal guidance on nirmatrelvir plus ritonavir and tocilizumab for treating COVID-19. So, molnupiravir is recommended for people with these risk factors.