Phase 1
Completed N=20
Efficacy and Safety of Molnupiravir in Healthy Participants Inoculated With Experimental Influenza Virus (MK-4482-019)
Influenza Infection
Source: ClinicalTrials.gov NCT05818124 ↗
Enrolled (actual)
20
Serious AEs
0.0%
Results posted
Aug 2025
Primary outcomePrimary: Part 1: Infectivity Rate Based on Quantitative Reverse Transcriptase-Polymerase Chain Reaction (qRT-PCR) From Day 1 PM Through Day 8 AM — 15 Participants
Summary
This is a phase 2a double-blind, randomized, placebo-controlled study to evaluate the efficacy and safety of molnupiravir (MK-4482) in healthy participants inoculated with experimental influenza virus. The primary hypotheses are that MK-4482 initiated 12 hours following intranasal inoculation of the influenza challenge virus reduces the peak viral load compared to placebo and that MK-4482 initiated 2 days following intranasal inoculation of the influenza challenge virus reduces the viral load area under the curve (AUC) compared to placebo.
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Part 1: Infectivity Rate Based on Quantitative Reverse Transcriptase-Polymerase Chain Reaction (qRT-PCR) From Day 1 PM Through Day 8 AM |
15 | — |
| PRIMARY Part 1: Infectivity Rate Based on Quantitative Reverse Transcriptase-Polymerase Chain Reaction (qRT-PCR) From Day 2 PM Through Day 8 AM |
14 | — |
| PRIMARY Part 1: Number of Participants Experiencing ≥1 Viral Challenge-related Adverse Event (AE) |
9 | — |
| PRIMARY Part 2: Peak Viral Load (PVL) Determined by Quantitative Viral Culture Tissue Culture Infective Dose 50% (TCID50) Assay From Day 1 PM Through Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
1.85; 2.79 | 0.110 |
| PRIMARY Part 2: Area Under the Viral Load-Time Curve (VL-AUC) Determined by QVC (TCID50 Assay) From Day 2 AM Through Day 8 AM After Intranasal Inoculation (Molnupiravir Tx and Placebo) |
2.74; 4.34 | 0.090 |
| SECONDARY Part 1: QVC-Confirmed Influenza Infection From Day 1 PM Through Day 8 AM After Intranasal Inoculation |
15 | — |
| SECONDARY Part 1: QVC-Confirmed Influenza Infection From Day 2 PM Through Day 8 AM After Intranasal Inoculation |
8 | — |
| SECONDARY Part 1: VL-AUC Determined by qRT-PCR From Day 1 PM Through Day 8 AM After Intranasal Inoculation |
17.29 | — |
| SECONDARY Part 1: VL-AUC Determined by qRT-PCR From Day 2 PM Through Day 8 AM After Intranasal Inoculation |
12.29 | — |
| SECONDARY Part 1: VL-AUC Determined by Quantitative Viral Culture (TCID50 Assay) From Day 1 PM Through Day 8 AM After Intranasal Inoculation |
5.45 | — |
| SECONDARY Part 1: VL-AUC Determined by Quantitative Viral Culture (TCID50 Assay) From Day 2 PM Through Day 8 AM After Intranasal Inoculation |
2.27 | — |
| SECONDARY Part 1: PVL Determined by qRT-PCR From Day 1 PM Through Day 8 AM After Intranasal Inoculation |
5.89 | — |
| SECONDARY Part 1: PVL Determined by qRT-PCR From Day 2 PM Through Day 8 AM After Intranasal Inoculation |
5.15 | — |
| SECONDARY Part 1: PVL Determined by Quantitative Viral Culture (TCID50 Assay) From Day 1 PM Through Day 8 AM After Intranasal Inoculation |
4.05 | — |
| SECONDARY Part 1: PVL Determined by Quantitative Viral Culture (TCID50 Assay) From Day 2 PM Through Day 8 AM After Intranasal Inoculation |
2.33 | — |
| SECONDARY Part 1: Duration in Days of Quantifiable Influenza Infection by qRT-PCR From Day 1 PM Through Day 8 AM After Intranasal Inoculation |
3.23 | — |
| SECONDARY Part 1: Duration in Days of Quantifiable Influenza Infection by qRT-PCR From Day 2 PM Through Day 8 AM After Intranasal Inoculation |
2.24 | — |
| SECONDARY Part 1: Duration in Days of Quantifiable Influenza Infection by QVC (TCID50 Assay) Confirmed Infection From Day 1 PM Through Day 8 AM After Intranasal Inoculation |
1.10 | — |
| SECONDARY Part 1: Duration in Days of Quantifiable Influenza Infection by QVC Confirmed Infection From Day 2 PM Through Day 8 AM After Intranasal Inoculation |
0.79 | — |
| SECONDARY Part 1: Area Under the Total Symptom Score-Time Curve (TSS-AUC) From Day 1 AM Through Day 8 AM After Intranasal Inoculation |
23.48 | — |
| SECONDARY Part 1: Area Under the Total Symptom Score-Time Curve (TSS-AUC) From Day 2 AM Through Day 8 AM After Intranasal Inoculation |
16.95 | — |
| SECONDARY Part 1: Peak Total Symptom Score (TSS) From Day 1 AM Through Day 8 AM After Intranasal Inoculation |
9.65 | — |
| SECONDARY Part 1: Peak Total Symptom Score (TSS) From Day 2 AM Through Day 8 AM After Intranasal Inoculation |
8.85 | — |
| SECONDARY Part 1: Daily Maximum TSS From Day 1 AM Through Day 8 AM After Intranasal Inoculation |
6.15; 8.65; 6.80; 4.85; 2.90; 2.05 | — |
| SECONDARY Part 1: Duration in Days of Grade ≥2 Symptoms From Day 1 AM Through Day 8 AM After Intranasal Inoculation |
2.65 | — |
| SECONDARY Part 1: Duration of Grade ≥2 Symptoms From Day 2 AM Through Day 8 AM After Intranasal Inoculation |
1.84 | — |
| SECONDARY Part 1: Time to Symptom Resolution From Day 1 AM Through Day 8 AM After Intranasal Inoculation |
4.15 | — |
| SECONDARY Part 1: Time to Symptom Resolution From Day 2 AM Through Discharge From Quarantine (Day 8 AM) After Intranasal Inoculation |
3.21 | — |
| SECONDARY Part 1: Time to Peak TSS From Day 1 AM Through Day 8 AM After Intranasal Inoculation |
1.24 | — |
| SECONDARY Part 2: VL-AUC Determined by qRT-PCR From Day 1 PM Through Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
11.10; 11.58 | 0.783 |
| SECONDARY Part 2: VL-AUC Determined by Quantitative Viral Culture (TCID50 Assay) From Day 1 PM Through Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
2.15; 4.36 | 0.032 sig |
| SECONDARY Part 2: PVL Determined by qRT-PCR From Day 1 PM Through Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
3.57; 3.37 | 0.756 |
| SECONDARY Part 2: Percentage of Participants With qRT-PCR-Confirmed Influenza Infection From Day 1 PM up to Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
40.00; 40.00 | — |
| SECONDARY Part 2: Percentage of Participants With qRT-PCR-Confirmed Symptomatic Influenza Infection From Day 1 PM up to Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
37.14; 40.00 | — |
| SECONDARY Part 2: Percentage of Participants With qRT-PCR-Confirmed Moderately Severe Symptomatic Influenza Infection From Day 1 PM up to Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
25.71; 34.29 | — |
| SECONDARY Part 2: Percentage of Participants With qRT-PCR-Confirmed Febrile Influenza Infection From Day 1 PM up to Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
17.14; 22.86 | — |
| SECONDARY Part 2: Percentage of Participants With QVC Confirmed Influenza Infection From Day 1 PM up to Day 8 AM After Intranasal Inoculations (Molnupiravir PEP and Placebo) |
17.14; 22.86 | — |
| SECONDARY Part 2: Percentage of Participants With QVC Confirmed Symptomatic Influenza Infection From Day 1 PM up to Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
14.29; 22.86 | — |
| SECONDARY Part 2: Duration of Quantifiable Infection Determined by qRT-PCR From Day 1 PM Through Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
2.61; 3.03 | — |
| SECONDARY Part 2: Duration of Quantifiable Infection Determined by QVC From Day 1 PM Through Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
0.58; 1.37 | — |
| SECONDARY Part 2: Time to Confirmed Negative Test Determined by qRT-PCR From Day 1 PM Through Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
0.0; 0.0 | 0.3102 |
| SECONDARY Part 2: Time to Confirmed Negative Test Determined by QVC (TCID50 Assay) From Day 1 PM Through Day 8 AM After Intranasal Inoculations (Molnupiravir PEP and Placebo) |
0.7; 0.0 | 0.0779 |
| SECONDARY Part 2: Time to PVL Determined by qRT-PCR From Day 1 PM Through Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
0.66; 1.04 | — |
| SECONDARY Part 2: Time to PVL Determined by QVC From Day 1 PM Through Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
0.74; 1.47 | — |
| SECONDARY Part 2: VL-AUC Determined by qRT-PCR From Day 1 PM Through Day 8 AM After Intranasal Inoculation (Molnupiravir Tx and Placebo) |
14.40; 18.19 | 0.045 sig |
| SECONDARY Part 2: VL-AUC Determined by qRT-PCR From Day 1 PM Through Day 8 AM After Intranasal Inoculation (OTV Tx and Placebo) |
15.62; 18.19 | 0.226 |
| SECONDARY Part 2: VL-AUC Determined by Quantitative Viral Culture (TCID50 Assay) From Day 1 PM Through Discharge Day 8 AM After Intranasal Inoculation (Molnupiravir Tx and Placebo) |
2.74; 4.34 | 0.090 |
| SECONDARY Part 2: VL-AUC Determined by Quantitative Viral Culture (TCID50 Assay) From Day 1 PM Through Day 8 AM After Intranasal Inoculation (OTV Tx and Placebo) |
5.08; 4.34 | 0.609 |
| SECONDARY Part 2: PVL Determined by Quantitative Viral Culture (TCID50 Assay) From Day 1 PM Through Day 8 AM After Intranasal Inoculation (Molnupiravir Tx and Placebo) |
3.33; 2.99 | 0.614 |
| SECONDARY Part 2: PVL Determined by Quantitative Viral Culture (TCID50 Assay) From Day 1 PM Through Day 8 AM After Intranasal Inoculation (OTV Tx and Placebo) |
3.36; 2.99 | 0.608 |
| SECONDARY Part 2: PVL Determined by qRT-PCR From Day 1 PM Through Day 8 AM After Intranasal Inoculation (Molnupiravir Tx and Placebo) |
6.74; 6.31 | 0.288 |
| SECONDARY Part 2: PVL Determined by qRT-PCR From Day 1 PM Through Day 8 AM After Intranasal Inoculation (OTV Tx and Placebo) |
6.39; 6.31 | 0.842 |
| SECONDARY Part 2: Duration of Quantifiable Infection Determined by qRT-PCR From Day 2 AM Through Day 8 AM After Intranasal Inoculation (Molnupiravir Tx, OTV Tx and Placebo) |
2.16; 2.67; 3.25 | — |
| SECONDARY Part 2: Duration of Quantifiable Infection Determined by QVC From Day 2 AM Through Day 8 AM After Intranasal Inoculation (Molnupiravir Tx, OTV Tx and Placebo) |
0.85; 1.90; 1.19 | — |
| SECONDARY Part 2: Time to Confirmed Negative Test Determined by qRT-PCR From Day 2 AM Through Day 8 AM After Intranasal Inoculation (Molnupiravir Tx and Placebo) |
2.5; 3.7 | 0.0042 sig |
| SECONDARY Part 2: Time to Confirmed Negative Test Determined by qRT-PCR From Day 1 PM Through Day 8 AM After Intranasal Inoculation (OTV Tx and Placebo) |
2.0; 3.7 | 0.3290 |
| SECONDARY Part 2: Time in Days to Confirmed Negative Test Determined by QVC From Day 2 AM Through Day 8 AM After Intranasal Inoculations (Molnupiravir Tx and Placebo) |
0.5; 1.0 | 0.1502 |
| SECONDARY Part 2: Time in Days to Confirmed Negative Test Determined by QVC From Day 2 AM Through Day 8 AM After Intranasal Inoculation (OTV Tx and Placebo) |
1.0; 1.0 | 0.4865 |
| SECONDARY Part 2: Time to PVL Determined by qRT-PCR From Day 1 PM Through Day 8 AM After Intranasal Inoculation (Molnupiravir Tx, OTV Tx and Placebo) |
0.19; 0.43; 1.53 | — |
| SECONDARY Part 2: Time to PVL Determined by QVC From Day 2 AM Through Day 8 AM After Intranasal Inoculation (Molnupiravir Tx, OTV and Placebo) |
0.11; 0.37; 1.14 | — |
| SECONDARY Part 2: Total Symptom Score AUC (TSS-AUC) From Day 2 AM Through Day 8 AM After Intranasal Inoculation (Molnupiravir Tx and Placebo) |
14.72; 19.51 | 0.313 |
| SECONDARY Part 2: Total Symptom Score AUC (TSS-AUC) From Day 2 AM Through Day 8 AM After Intranasal Inoculation (OTV Tx and Placebo) |
12.64; 19.51 | 0.138 |
| SECONDARY Part 2: Peak TSS From Day 2 AM Through Day 8 AM After Intranasal Inoculation (Molnupiravir Tx and Placebo) |
9.38; 8.64 | 0.706 |
| SECONDARY Part 2: Peak TSS From Day 2 AM Through Day 8 AM After Intranasal Inoculation (OTV Tx and Placebo) |
7.07; 8.64 | 0.367 |
| SECONDARY Part 2: Daily Maximum TSS From Day 2 AM Through Day 8 AM After Intranasal Inoculation (Molnupiravir Tx, OTV Tx and Placebo) |
9.15; 6.93; 7.57; 7.08; 5.27; 6.50 | — |
| SECONDARY Part 2: Daily Maximum TSS From Day 1 AM Through Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
2.20; 1.94; 4.09; 4.71; 2.69; 4.09 | — |
| SECONDARY Part 2: Duration of Grade ≥2 Symptoms From Day 2 AM Through Day 8 AM After Intranasal Inoculation (Molnupiravir Tx, OTV Tx and Placebo) |
2.16; 2.10; 2.43 | — |
| SECONDARY Part 2: Time to Symptom Resolution From Day 2 AM Through Day 8 AM After Intranasal Inoculation (Molnupiravir Tx, OTV Tx and Placebo) |
3.78; 3.48; 4.07 | — |
| SECONDARY Part 2: Time to Peak TSS From Day 2 AM Through Day 8 AM After Intranasal Inoculation (Molnupiravir Tx, OTV Tx and Placebo) |
0.25; 0.14; 0.90 | — |
| SECONDARY Part 2: Total Symptom Score AUC (TSS-AUC) From Day 1 AM Through Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
8.84; 12.98 | 0.177 |
| SECONDARY Part 2: Peak TSS From Day 1 AM Through Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
4.66; 5.63 | 0.395 |
| SECONDARY Part 2: Duration of Grade ≥2 Symptoms From Day 1 AM Through Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
1.78; 2.04 | — |
| SECONDARY Part 2: Time to Symptom Resolution From Day 1 AM Through Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
3.14; 3.44 | — |
| SECONDARY Part 2: Time to Peak TSS From Day 1 AM Through Day 8 AM After Intranasal Inoculation (Molnupiravir PEP and Placebo) |
1.77; 1.54 | — |
| SECONDARY Part 2: Number of Participants With One or More AE (Molnupiravir Tx and Molnupiravir PEP) |
8; 11 | — |
| SECONDARY Part 2: Number of Participants Discontinuing Study Treatment Due to an AE (Molnupiravir Tx and Molnupiravir PEP) |
0; 0 | — |
| SECONDARY Number of Participants With One or More Viral Challenge-Related AE |
9; 1; 2; 3; 6 | — |
| SECONDARY Part 2: Number of Participants With Concomitant Medication Use From Viral Challenge Through Day 28 |
18; 10; 10; 17 | — |
| SECONDARY Maximum Plasma Concentration (Cmax) of N-hydroxycytidine (NHC) |
3730; 3680 | — |
| SECONDARY Time to Maximum Plasma Concentration (Tmax) of NHC |
1.68; 1.69 | — |
| SECONDARY Area Under the Plasma Concentration From 0 to 12 Hours Postdose (AUC0-12) of NHC |
9870; 9460 | — |
| SECONDARY Area Under the Plasma Concentration From Dosing to Last Measurable Concentration (AUC0-Last) of NHC |
10300; NA | — |
| SECONDARY Ctrough of NHC |
23.8; 21 | — |
| SECONDARY t1/2 of NHC |
22.1; NA | — |
Eligibility Criteria
Inclusion Criteria
- Is in good health based on medical history, physical examination, vital sign measurements, spirometry, and electrocardiograms performed before inoculation.
- Has a total body weight ≥50 kg and Body Mass Index (BMI) ≥18 kg/m^2 and ≤35 kg/m^2.
- For males: abstains from heterosexual intercourse as their preferred and usual lifestyle and agrees to remain abstinent OR uses contraception unless confirmed to be azoospermic.
- For participants assigned female sex at birth: is not pregnant or breastfeeding, AND is either not a person of childbearing potential (POCBP) or is a POCBP AND uses a contraceptive method that is highly effective (low user dependency method, OR a user dependent hormonal method in combination with barrier method), or is abstinent from penile-vaginal intercourse as their preferred and usual lifestyle, has a negative highly sensitive pregnancy test, abstains from breastfeeding, and has medical, menstrual, and recent sexual activity history reviewed by the investigator to decrease risk of early undetected pregnancy.
Exclusion Criteria
- Has a history of, or has currently active, symptoms or signs suggestive of upper or lower respiratory tract infection within 4 weeks prior to admission to quarantine.
- Has a history of clinically significant endocrine, gastrointestinal (GI), cardiovascular, hematological, hepatic, immunological, renal, respiratory, genitourinary, or major neurological abnormalities or diseases.
- Is mentally or legally incapacitated, has significant emotional problems at the time of prestudy visit, or expected during the conduct of the study, or has a history of clinically significant psychiatric disorder of the last 5 years.
- Has a history of cancer.
- Has a history of rhinitis which is clinically active, or history of moderate to severe rhinitis, or history of seasonal allergic rhinitis likely to be active at the time of inclusion into the study and/or requiring regular nasal corticosteroids on an at least weekly basis, within 30 days prior to admission to quarantine.
- Has a history of atopic dermatitis/eczema which is clinically severe and/or requiring moderate to large amounts of daily dermal corticosteroids.
- Has a diagnosis of cluster headache/migraine or is receiving prophylaxis against migraine.
- Has a lifetime history of anaphylaxis and/or a lifetime history of severe allergic reaction. Significant intolerance to any food or drug in the last 12 months.
- Has had major surgery and/or donated or lost 1 unit of blood within 3 months prior to the prestudy visit.
- Uses or anticipates the use of concomitant medications, including vitamins or herbal and dietary supplements from approximately 2 weeks prior to the planned date of viral challenge until the poststudy visit.
- Has evidence of receipt of vaccine within the 4 weeks prior to the planned date of viral challenge.
- Intends to receive any vaccine(s) before the last day of follow-up.
- Has received any investigational drug within 3 months prior to the planned date of viral challenge.
- Has received 3 or more investigational drugs within the previous 12 months prior to the planned date of viral challenge.
- Has had prior inoculation with a virus from the same virus subtype as the challenge virus.
- Has had prior inoculation with a virus from the same virus-family as the challenge virus in the last 12 months.
- Has had prior participation in another human viral challenge study with a respiratory virus in the preceding 3 months, taken from the date of viral challenge in the previous study to the date of expected viral challenge in this study.
- Has smoked ≥10 pack-years at any time.
- Has a recent history or presence of alcohol addiction, or excessive use of alcohol.
- Consumes excessive amounts, defined as more than 6 servings of caffeinated beverages or xanthine-containing products.
- Has any significant abnormality altering the anatomy of the nose in a substantial way or nasopharynx that may interfere with the
Data sourced from ClinicalTrials.gov (NCT05818124). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication. Informational only — not medical advice.