A Randomised, Multi-centre, Double-blind, Phase 3 Study to Observe the Effectiveness, Safety and Tolerability of Molnupiravir Compared to Placebo Administered Orally to High-risk Adult Outpatients With Mild COVID-19 Receiving Local Standard of Care in South Africa (CoTeT)

This is a Multi-centre, Double-blind, Phase 3 Study to Observe the Effectiveness, Safety, and Tolerability of Molnupiravir 800 mg Administered 12-hourly for Five Days to Adult Patients With Mild COVID-19 at the Time of Enrolment Who Are at Risk of Progression to Severe Disease, Compared to a Placebo. Patients With Recent Onset of COVID-19 Symptoms Will be Screened to Assess Eligibility for Enrolment. Confirmation of SARS-CoV-2 Infection Will be Performed Through Rapid Antigen Detection Using the LumiraDx Point of Care Diagnostic Platform.

This is a multi-centre, double-blind, phase 3 study to observe the effectiveness, safety, and tolerability of molnupiravir 800 mg administered 12-hourly for five days in adult patients with mild COVID-19 at the time of enrolment, who are at risk of progression to severe disease, compared to a placebo.

Study Overview

• Status: Completed
• Conditions: COVID-19
• Intervention / Treatment: Drug: Molnupiravir 200 mg

Detailed Description

This is a multi-centre, double-blind, phase 3 study to observe the effectiveness, safety, and tolerability of molnupiravir 800 mg administered 12-hourly for five days in adult patients with mild COVID-19 at the time of enrolment, who are at risk of progression to severe disease, compared to a placebo.

Patients with recent onset of COVID-19 symptoms will be screened to assess eligibility for enrolment. Confirmation of SARS-CoV-2 infection will be performed through rapid antigen detection using the LumiraDx point of care diagnostic platform. Approximately 4000 eligible patients will be enrolled and will be randomised in a 1:1 manner to start treatment with either molnupiravir or a placebo on the same day. Patients will record their symptoms (through a self-administered questionnaire) and self-observed vital signs daily for 10 days from the time of enrolment and will be contacted by study team personnel on Days 3, 6 and 10 to monitor their well-being. Adverse event and concomitant medication data will be collected. A final end-of-study follow-up visit will be conducted on Day 29.

An independent Data and Safety Monitoring Board (DSMB) will be convened for this study with expertise in COVID-19 or respiratory viruses, and emerging epidemics. The purpose of the DSMB is to monitor the study for safety and operational futility.

In addition to the usual, regular, required reporting to SAHPRA, the investigator anticipates that additional reporting will be required by the Clinical Trials Committee, noting the severity of the 3rd and 4th waves, the level of ''breakthrough'' infections in the context of high background comorbidities, and the urgent interest in this class of drugs.

• Study Type: Interventional
• Enrollment (Actual): 59
• Phase: Phase 2; Phase 3

Contacts and Locations

Study Locations

• South Africa
  • Eastern Cape
    • Umtata, Eastern Cape, South Africa, 5099
      • Nelson Mandela Academic Clinical Research Unit (NeMACRU)
  • Gauteng
    • Johannesburg, Gauteng, South Africa, 2193
      • Sunnyside Office Park
  • Kwa-Zulu Natal
    • Durban, Kwa-Zulu Natal, South Africa, 3935
      • Nelson R. Mandela School of Medicine 3rd Floor, K-RITH Tower Building
  • North West
    • Klerksdorp, North West, South Africa, 2571
      • The Aurum Institute: Gavin J Churchyard Legacy Centre Klerksdorp Clinical Research Centre

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 46 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. Able and willing to provide written or electronic informed consent prior to any study-specific procedure.
2. Age ≥50 at the time of signing the informed consent form.
3. Women of reproductive potential must have a negative pregnancy test at screening and be using a highly effective method of contraception. Highly effective methods of contraception
4. A male participant must wear a condom when engaging in any activity that allows for passage of ejaculate to another while taking the investigational product. Male participants should also be advised of the benefit for a female partner to use a highly effective method of contraception as condom may break or leak.
5. Self-reported symptoms of COVID-19 with onset no more than five days prior to screening informed consent including at least one of, fever or chills, cough, sore throat, rhinorrhoea or rhinitis or sinusitis, shortness of breath, headache, myalgia, new onset anosmia or ageusia, nausea, diarrhoea, or extreme fatigue, or other symptoms recognized in local and international guidelines as typical of mild COVID-19.
6. SARS-CoV-2 infection confirmed through a positive LumiraDx rapid antigen test on the day of screening or a positive RT-PCR within two days prior to screening.

7. Participant is at high risk for progression to severe COVID-19, this defined as either:

   1. Age ≥50 with at least one of the following background or medical conditions: diabetes mellitus, obesity (BMI 30 kg/m2), hypertension, HIV, active or previous TB.
   2. Age ≥65

8. Participant agrees to comply with study procedures, including the completion of a daily diary for 10 days from the time of enrolment, and to be available for study contacts and visits.

   -

Exclusion Criteria:

1. Pregnant or breastfeeding women, or women planning/desiring to become pregnant during the 28 days following enrolment into the study.
2. Duration of self-reported symptoms of COVID-19 for more than five days prior to screening.
3. Signs of respiratory distress or severe disease prior to enrolment, including:
4. Inability/unlikely to be in the study area for the duration of the 28-day follow-up period.
5. Inability to tolerate oral medications.
6. Any surgical or medical condition which might significantly alter the absorption, distribution, metabolism, or excretion of drugs, or which may jeopardize the safety of the patient or the objectives of the study. The Investigator should make this determination in consideration of the volunteer's medical history.
7. The volunteer is assessed to be clinically unstable in the Investigator's opinion.
8. Participation in another investigational study involving an investigational product within 30 days, or 5 half-lives, whichever is longer, prior to screening.
9. Personnel (e.g., investigator, sub-investigator, research assistant, pharmacist, study coordinator or anyone mentioned in the delegation log) directly involved in the conduct of the study.
10. Any physical, mental, or social condition, drug/alcohol use, history of illness or laboratory abnormality that, in the Investigator's judgment, might jeopardise the safety of the patient in the context of this study, or might interfere with study procedures or the ability of the subject to adhere to and complete the study. The Investigator should make this determination in consideration of the volunteer's medical history.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Monulpiravir; Eligible participants will be randomised in a 1:1 manner to receive either molnupiravir 800 mg orally approximately 12-hourly for five days or a placebo for the equivalent amount of time.	Drug: Molnupiravir 200 mg; The drug is orally bioavailable (and is indicated for treatment of mild to moderate COVID-19 in adults with a positive SARS-COV-2 diagnostic test and who have at least one risk factor for developing severe illness. The recommended dose is 800 mg (four 200 mg capsules) taken orally 12-hourly for five days, and should be administered as soon as possible after diagnosis of COVID-19 has been made and within five days of symptom onset.
Placebo Comparator: Placebo; Eligible participants will be randomised in a 1:1 manner to receive either molnupiravir 800 mg orally approximately 12-hourly for five days or a placebo for the equivalent amount of time.	Drug: Molnupiravir 200 mg; The drug is orally bioavailable (and is indicated for treatment of mild to moderate COVID-19 in adults with a positive SARS-COV-2 diagnostic test and who have at least one risk factor for developing severe illness. The recommended dose is 800 mg (four 200 mg capsules) taken orally 12-hourly for five days, and should be administered as soon as possible after diagnosis of COVID-19 has been made and within five days of symptom onset.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To evaluate the effectiveness of molnupiravir compared to placebo in preventing severe disease progression in adults with mild COVID-19	Combination of incidence of COVID-19-related hospitalisation (24 hours of care in a hospital or similar acute care facility) and COVID-19-related mortality to Day 29	29 Days
To evaluate the safety of molnupiravir in adults with mild COVID-19	Adverse events (including serious adverse events and adverse drug reactions)	29 Days
To evaluate the safety of molnupiravir in adults with mild COVID-19	Self-assessed vital signs to Day 10	29 Days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To facilitate same-day COVID-19 diagnosis and treatment initiation in adults with mild COVID-19 and comorbid conditions	Proportion of enrolled patients for whom diagnosis and same day treatment initiation was facilitated through use of a LumiraDx™ rapid antigen test	29 Days
To assess the tolerability of molnupiravir in adults with mild COVID-19	Severity of adverse events	29 Days
To assess the tolerability of molnupiravir in adults with mild COVID-19	Adverse event-related study drug discontinuations	29 Days
To describe time to symptom resolution in adults with mild COVID-19 treated with molnupiravir compared to placebo	Time to sustained resolution of symptoms as reported in the Flu-PRO© Plus	29 Days
To evaluate maximum COVID-19 disease severity in adults treated with molnupiravir compared to placebo	Maximum score on the WHO Clinical Progression Scale from Day 1 to Day 29	29 Days
To evaluate the relationship between effectiveness of molnupiravir and time between onset of symptoms and initiation of treatment	Number of days from symptom onset to initiation of treatment	29 Days
To evaluate the relationship between effectiveness of molnupiravir and time between onset of symptoms and initiation of treatment	Incidence of hospitalisation (24 hours of care in a hospital or similar acute care facility) and/or death to Day 29 in patients with co-morbid conditions	29 Days
To evaluate the relationship between effectiveness of molnupiravir and time between onset of symptoms and initiation of treatment	Time to sustained resolution of symptoms as reported in the Flu-PRO Plus	Day 1 to Day 10 and Day 29
To evaluate the relationship between effectiveness of molnupiravir and time between onset of symptoms and initiation of treatment	Maximum score on the WHO Clinical Progression Scale from Day 1 to Day 29. On a scale of 0 to 10 (0 being uninfected and 10 being worse/death)	Day 0, 3, 6, 10, 29
To describe adherence to a 5-day course of molnupiravir in adults with mild COVID-19	Proportion of patients completing the course of molnupiravir as prescribed	29 Days
To describe the utilisation of health care services by adults with mild COVID-19 treated with molnupiravir compared to placebo	Rate of hospital, emergency facility, clinic, health care practitioner or home visits to Day 29	29 Days
To report the incidence and outcome of pregnancies in female participants who received molnupiravir	Incidence of pregnancy in female participants to Day 29	29 Days
To report the incidence and outcome of pregnancies in female participants who received molnupiravir	20-week gestational age ultrasound findings	Once
To report the incidence and outcome of pregnancies in female participants who received molnupiravir	Pregnancy complications	Throughout the pregnancy
To report the incidence and outcome of pregnancies in female participants who received molnupiravir	Pregnancy outcome	Once
To report the incidence and outcome of pregnancies in female participants who received molnupiravir	Infant wellbeing to three months of age	Once

Collaborators and Investigators

• Sponsor: University of Witwatersrand, South Africa
• Collaborators: Bill and Melinda Gates Foundation
• Investigators: Study Director: Francois WD Venter, Ezintsha, Faculty of Health Sciences University of the Witwatersrand

Study record dates

Study Major Dates

• Study Start (Actual): August 12, 2022
• Primary Completion (Actual): July 7, 2023
• Study Completion (Actual): September 30, 2023

Study Registration Dates

• First Submitted: July 13, 2022
• First Submitted That Met QC Criteria: July 14, 2022
• First Posted (Actual): July 15, 2022

Study Record Updates

• Last Update Posted (Estimated): July 1, 2025
• Last Update Submitted That Met QC Criteria: June 26, 2025
• Last Verified: June 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Respiratory Tract Infections; Infections; RNA Virus Infections; Virus Diseases; Respiratory Tract Diseases; Lung Diseases; Pneumonia, Viral; Pneumonia; Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; COVID-19; Anti-Infective Agents; Antiviral Agents; Molnupiravir
• Other Study ID Numbers: EZ-SS-029

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The data that will be shared is all of the individual participant data collected during the trial, after deidentification.
• IPD Sharing Time Frame: Immediately following publication
• IPD Sharing Access Criteria: Anyone who wishes to access the data
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No