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, sotrovimab and tocilizumab for treating COVID-19) and
both nirmatrelvir plus ritonavir and sotrovimab are contraindicated or unsuitable.
Why the committee made this recommendation
Usual treatment for mild to moderate COVID‑19 in people at risk of developing severe COVID‑19 includes nirmatrelvir plus ritonavir, or sotrovimab when nirmatrelvir plus ritonavir is unsuitable. There are no other treatment options when these medicines 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, or sotrovimab. 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, sotrovimab and tocilizumab for treating COVID-19. So, molnupiravir is recommended for people with these risk factors.