Randomized Clinical Trial Shows That COVID-19 Antivirals Paxlovid or Molnupiravir Does Not Help Hospitalized Patients
Nikhil Prasad Fact checked by:Thailand Medical News Team Jun 27, 2025 4 hours, 36 minutes ago
Medical News: A new large-scale clinical trial has found that popular antiviral drugs used to treat COVID-19—namely molnupiravir and nirmatrelvir-ritonavir (commonly known as Paxlovid)—do not provide any significant benefit to patients who are already hospitalized with the virus. This surprising finding challenges earlier false claims that these medications might help reduce death rates or speed up recovery for severe COVID-19 cases.
Randomized Clinical Trial Shows That COVID-19 Antivirals Paxlovid or Molnupiravir Does Not Help
Hospitalized Patients
The international study, led by researchers from the Nuffield Department of Medicine at the University of Oxford in England, carefully tested the effects of these oral antivirals during the Omicron variant wave. In this
Medical News report, researchers highlight that the medications had no meaningful effect on how long patients stayed in the hospital, their chances of needing a ventilator, or their risk of dying within 28 days of admission.
How the Study Was Conducted
The clinical trial was a randomized, controlled one—the gold standard in medical research. A total of 445 hospitalized patients with confirmed COVID-19 were given molnupiravir, while another 68 received nirmatrelvir-ritonavir. Their average ages were 71.4 and 72.5 years, respectively, and the vast majority had already been vaccinated against COVID-19. These patients received the antiviral drugs in addition to usual hospital care.
To ensure a fair comparison, each patient who received an antiviral was matched with another patient who got only standard care, with no antivirals. This allowed researchers to assess whether these drugs offered any added benefit in real-world hospital settings.
What the Results Showed
The results were clear: neither molnupiravir nor nirmatrelvir-ritonavir made a noticeable difference.
For those taking molnupiravir, there was no significant improvement in 28-day survival compared to those who received usual care. The hazard ratio—a statistical measure—was 0.93, indicating no real benefit, with a P-value of 0.66, which confirms the result was not statistically significant. Similarly, the time it took for patients to be discharged alive from the hospital was nearly identical between the two groups.
The outcomes for nirmatrelvir-ritonavir (Paxlovid) were also underwhelming. The hazard ratio for death within 28 days was 1.02, meaning no reduction in risk. The time to discharge alive was not significantly better either, with a hazard ratio of 0.80. The chances of a patient ending up on a ventilator or dying during hospitalization also did not differ between those who received antivirals and those who did not (risk ratio of 0.96; P = .75).
Why This Matters
This study delivers a sobering reality check. Antivirals like molnupiravir and Paxlovid have shown some success in reducing symptoms and complication
s when given early in the course of COVID-19, especially to high-risk patients in outpatient settings. However, this new trial makes it clear that once a person is sick enough to require hospitalization, these drugs offer no added benefit.
Doctors had hoped that these medications might still help slow the virus's progression in severely ill patients, but this study suggests otherwise. As noted by experts who commented on the findings, the small sample size for Paxlovid patients makes it hard to draw absolute conclusions, but even with that limitation, no trend toward benefit was seen.
What the Researchers Say
The lead author, Professor Peter Horby of the University of Oxford, emphasized the importance of reevaluating how and when these drugs should be used. “Interpreting the results of this study, it is unlikely that adding molnupiravir to usual care has significant clinical benefit in this group of patients,” the researchers noted. Regarding Paxlovid, they acknowledged that the low number of participants limits the certainty of conclusions, but the data still failed to show any real improvement.
Final Thoughts
This study adds to growing evidence that the timing of treatment is crucial when battling COVID-19. While antivirals may still play a role in preventing hospitalization or in early treatment of high-risk individuals, once a patient is in the hospital, other therapeutic approaches—like anti-inflammatory drugs or oxygen support—remain the mainstay of care.
The findings urge medical professionals to refine treatment strategies and reserve oral antivirals for cases where they are truly effective. These insights are vital as health systems around the world continue to manage new COVID-19 cases and prepare for future variants.
The study findings were published in the peer-reviewed journal: The Lancet Infectious Diseases.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(25)00093-3/fulltext
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