Comparison between available early antiviral treatments in outpatients with SARS-CoV-2 infection: a real-life study

• Published in: BMC infectious diseases 2023-10, Vol.23 (1), p.1-646, Article 646
• Main Authors: Rinaldi, Matteo, Campoli, Caterina, Gallo, Mena, Marzolla, Domenico, Zuppiroli, Alberto, Riccardi, Riccardo, Casarini, Martina, Riccucci, Daniele, Malosso, Marta, Bonazzetti, Cecilia, Pascale, Renato, Tazza, Beatrice, Pasquini, Zeno, Marconi, Lorenzo, Curti, Stefania, Giannella, Maddalena, Viale, Pierluigi
• Format: Article
• Language: English
• Subjects: Antiviral agents; Care and treatment; COVID-19; COVID-19 vaccines; Dosage and administration; Drug dosages; Early antiviral treatment, real-life cohort; Health aspects; Health services; Hospital care; Hospitalization; Hospitals; Immunization; Immunosuppression; Infections; Infectious diseases; Medical research; Medicine, Experimental; Mortality; Outpatients; Patients; Physicians; Prevention; Recovery; Regression models; Risk factors; Ritonavir; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Statistical analysis; Surveys; Vaccination
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-023-08538-9

To investigate the clinical impact of three available antivirals for early COVID-19 treatment in a large real-life cohort. Between January and October 2022 all outpatients tested positive for SARS-CoV-2 referring to IRCCS S. Orsola hospital treated with an early antiviral therapy were enrolled. A comparison between patients treated with nirmatrelvir/ritonavir (NTV/r), molnupiravir (MPV) and remdesivir (RDV) was conducted in term of indications and outcome. To account for differences between treatment groups a propensity score analysis was performed. After estimating the weights, we fitted a survey-weighted Cox regression model with inverse-probability weighting with hospital admission/death versus clinical recovery as the primary outcome. Overall 1342 patients were enrolled, 775 (57.8%), 360 (26.8%) and 207 (15.4%) in MPV, NTV/r and RDV group, respectively. Median age was 73 (59-82) years, male sex was 53.4%. Primary indication was immunosuppression (438, 32.6%), the median time from symptom onset to drug administration was 3 [2-4] days. Overall, clinical recovery was reached in 96.9% of patients, with hospital admission rate of 2.6%. No significant differences were found in clinical recovery nor hospitalization. Cox regression showed a decreased probability of hospital admission/ death among prior vaccinated patients compared with unvaccinated (HR 0.31 [95%CI 0.14-0.70], p = 0.005]). No difference in hospitalization rates in early treatment compared to late treatment were found. No differences among MPV, NTV/r and RDV in terms of clinical recovery or hospitalization were found. Patients not vaccinated had a significant increased risk of hospitalization.