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Making Statistical Sense of the Molnupiravir MOVe-OUT Clinical Trial

Thorlund, Kristian
Sheldrick, Kyle
Meyerowitz-Katz, Gideon
Singh, Sonal
Hill, Andrew
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Journal Article
Publication Date
2022-03-11
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Abstract

Oral therapies for the early treatment of COVID-19 may prevent disease progression and health system overcrowding. A new oral therapeutic named molnupiravir has been promoted as providing an approximately 50% reduction in death or the need for hospitalization. The clinical trial evaluating this drug was stopped early at the recommendation of the Data Safety and Monitoring Board after approximately 50% of the sample had been recruited. At the point of discontinuing the trial, approximately 90% of the planned sample had been recruited and had available follow-up data accessible. We discuss issues about the study conduct, analysis, and interpretation, including 1) the authors and sponsors presented the interim analysis as the primary analysis; 2) communication between sponsors and the Data Safety and Monitoring Board was insufficient; 3) the treatment effects reverse when examining only the post-interim analysis population, and are substantially attenuated when examining the full data; 4) the choice of primary analysis is incorrect; 5) analysis of lost-to-follow-up patients favors the study drug; and 6) other known molnupiravir trials were not presented in the primary study findings. As a result of methodological and statistical concerns, it seems that external trials, separate from those supported by the sponsoring company, are required to determine the utility of this drug.

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Thorlund K, Sheldrick K, Meyerowitz-Katz G, Singh S, Hill A. Making Statistical Sense of the Molnupiravir MOVe-OUT Clinical Trial. Am J Trop Med Hyg. 2022 Mar 11;106(5):1301–4. doi: 10.4269/ajtmh.21-1339. Epub ahead of print. PMID: 35276667; PMCID: PMC9128711.

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DOI
10.4269/ajtmh.21-1339
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35276667
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This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unre- stricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Attribution 4.0 International