Real-world Effectiveness of Molnupiravir and Nirmatrelvir/Ritonavir as Treatments for COVID-19 in Patients at High Risk

• Published in: The Journal of infectious diseases 2023-12, Vol.228 (12), p.1667-1674
• Main Authors: Paraskevis, Dimitrios, Gkova, Maria, Mellou, Kassiani, Gerolymatos, Gerasimos, Psalida, Naya, Gkolfinopoulou, Kassiani, Kostaki, Evangelia-Georgia, Loukides, Stylianos, Kotanidou, Anastasia, Skoutelis, Athanasios, Thiraios, Eleftherios, Saroglou, Georgios, Zografopoulos, Dimitrios, Filippou, Dimitrios, Mossialos, Elias, Zaoutis, Theoklis, Gaga, Mina, Tsiodras, Sotirios, Antoniadou, Anastasia
• Format: Article
• Language: English
• Subjects: Aged; Antiviral Agents - therapeutic use; COVID-19; COVID-19 Drug Treatment; Humans; Major; Retrospective Studies; Ritonavir - therapeutic use; SARS-CoV-2
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jiad324

Abstract Background Using a retrospective cohort study design, we aimed to evaluate the effectiveness of molnupiravir and nirmatrelvir/ritonavir in patients with SARS-CoV-2 who were highly vulnerable. Methods The impact of each drug was determined via comparisons with age-matched control groups of patients positive for SARS-CoV-2 who did not receive oral antiviral therapy. Results Administration of molnupiravir significantly reduced the risk of hospitalization (odds ratio [OR], 0.40; P < .001) and death (OR, 0.31; P < .001) among these patients based on data adjusted for age, previous SARS-CoV-2 infection, vaccination status, and time elapsed since the most recent vaccination. The reductions in risk were most profound among elderly patients (≥75 years old) and among those with high levels of drug adherence. Administration of nirmatrelvir/ritonavir also resulted in significant reductions in the risk of hospitalization (OR, 0.31; P < .001) and death (OR, 0.28; P < .001). Similar to molnupiravir, the impact of nirmatrelvir/ritonavir was more substantial among elderly patients and in those with high levels of drug adherence. Conclusions Collectively, these real-world findings suggest that although the risks of hospitalization and death due to COVID-19 have been reduced, antivirals can provide additional benefits to members of highly vulnerable patient populations. Molnupiravir significantly reduced the risk of hospitalization (odds ratio [OR], 0.40) and death (OR, 0.31) among patients aged ≥65 years. Nirmatrelvir/ritonavir use similarly resulted in significant reductions in the risk of hospitalization (OR, 0.31) and death (OR, 0.28).