Real-World Study on Effectiveness of Molnupiravir and Nirmatrelvir-Ritonavir in Unvaccinated Patients with Chronic Respiratory Diseases with Confirmed SARS-CoV-2 Infection Managed in Out-Patient Setting

• Published in: Viruses 2023-02, Vol.15 (3), p.610
• Main Authors: Kwok, Wang Chun, Tsoi, Man Fung, Leung, Sze Him Isaac, Tsui, Chung Ki, Tam, Terence Chi Chun, Ho, James Chung Man, Lam, David Chi Leung, Ip, Mary Sau Man, Ho, Pak Leung
• Format: Article
• Language: English
• Subjects: Adult; Antiviral agents; Antiviral Agents - therapeutic use; Asthma; Bronchiectasis; Care and treatment; Chronic illnesses; Chronic infection; Chronic obstructive pulmonary disease; Clinics; COPD; Coronaviruses; COVID-19; COVID-19 Drug Treatment; COVID-19 vaccines; Development and progression; Dosage and administration; Drug therapy; Hospital patients; Hospitalization; Hospitals; Humans; Immunization; Infections; Lung diseases; molnupiravir; Mortality; nirmatrelvir–ritonavir; Obstructive lung disease; Outpatients; Patient outcomes; Patients; Respiratory diseases; Respiratory failure; Respiratory Insufficiency - drug therapy; Respiratory tract diseases; Retrospective Studies; Ritonavir; Ritonavir - therapeutic use; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Statistics; Ventilators
• ISSN: 1999-4915; 1999-4915
• DOI: 10.3390/v15030610

While molnupiravir (MOV) and nirmatrelvir-ritonavir (NMV-r) were developed for treatment of mild to moderate COVID-19 infection, there has been a lack of data on the efficacy among unvaccinated adult patients with chronic respiratory diseases, including asthma, chronic obstructive pulmonary disease (COPD) and bronchiectasis. A territory-wide retrospective cohort study was conducted in Hong Kong to investigate the efficacy of MOV and NMV-r against severe outcomes of COVID-19 in unvaccinated adult patients with chronic respiratory diseases. A total of 3267 patients were included. NMV-r was effective in preventing respiratory failure (66.6%; 95% CI, 25.6-85.0%, 0.007), severe respiratory failure (77.0%; 95% CI, 6.9-94.3%, 0.039) with statistical significance, and COVID-19 related hospitalization (43.9%; 95% CI, -1.7-69.0%, 0.057) and in-hospital mortality (62.7%; 95% CI, -0.6-86.2, 0.051) with borderline statistical significance. MOV was effective in preventing COVID-19 related severe respiratory failure (48.2%; 95% CI 0.5-73.0, 0.048) and in-hospital mortality (58.3%; 95% CI 22.9-77.4, 0.005) but not hospitalization ( 0.16) and respiratory failure ( 0.10). In summary, both NMV-r and MOV are effective for reducing severe outcomes in unvaccinated COVID-19 patients with chronic respiratory diseases.