Ontology highlight
ABSTRACT: Background
Whether hospitalized patients benefit from COVID-19 oral antivirals is uncertain.Objective
To examine the real-world effectiveness of molnupiravir and nirmatrelvir-ritonavir in hospitalized patients with COVID-19 during the Omicron outbreak.Design
Target trial emulation study.Setting
Electronic health databases in Hong Kong.Participants
The molnupiravir emulated trial included hospitalized patients with COVID-19 aged 18 years or older between 26 February and 18 July 2022 (n = 16 495). The nirmatrelvir-ritonavir emulated trial included hospitalized patients with COVID-19 aged 18 years or older between 16 March and 18 July 2022 (n = 7119).Intervention
Initiation of molnupiravir or nirmatrelvir-ritonavir within 5 days of hospitalization with COVID-19 versus no initiation of molnupiravir or nirmatrelvir-ritonavir.Measurements
Effectiveness against all-cause mortality, intensive care unit (ICU) admission, or use of ventilatory support within 28 days.Results
The use of oral antivirals in hospitalized patients with COVID-19 was associated with a lower risk for all-cause mortality (molnupiravir: hazard ratio [HR], 0.87 [95% CI, 0.81 to 0.93]; nirmatrelvir-ritonavir: HR, 0.77 [CI, 0.66 to 0.90]) but no significant risk reduction in terms of ICU admission (molnupiravir: HR, 1.02 [CI, 0.76 to 1.36]; nirmatrelvir-ritonavir: HR, 1.08 [CI, 0.58 to 2.02]) or the need for ventilatory support (molnupiravir: HR, 1.07 [CI, 0.89 to 1.30]; nirmatrelvir-ritonavir: HR, 1.03 [CI, 0.70 to 1.52]). There was no significant interaction between drug treatment and the number of COVID-19 vaccine doses received, thereby supporting the effectiveness of oral antivirals regardless of vaccination status. No significant interaction between nirmatrelvir-ritonavir treatment and age, sex, or Charlson Comorbidity Index was observed, whereas molnupiravir tended to be more effective in older people.Limitation
The outcome of ICU admission or need for ventilatory support may not capture all severe COVID-19 cases; unmeasured confounders, such as obesity and health behaviors, may exist.Conclusion
Molnupiravir and nirmatrelvir-ritonavir reduced all-cause mortality in both vaccinated and unvaccinated hospitalized patients. No significant reduction in ICU admission or the need for ventilatory support was observed.Primary funding source
Health and Medical Research Fund Research on COVID-19, Government of the Hong Kong Special Administrative Region; Research Grants Council, Collaborative Research Fund; and Health Bureau, Government of the Hong Kong Special Administrative Region.
SUBMITTER: Wan EYF
PROVIDER: S-EPMC10052319 | biostudies-literature | 2023 Mar
REPOSITORIES: biostudies-literature
Wan Eric Yuk Fai EYF Yan Vincent Ka Chun VKC Mok Anna Hoi Ying AHY Wang Boyuan B Xu Wanchun W Cheng Franco Wing Tak FWT Lai Francisco Tsz Tsun FTT Chui Celine Sze Ling CSL Li Xue X Wong Carlos King Ho CKH Li Philip Hei PH Cowling Benjamin John BJ Hung Ivan Fan Ngai IFN Lau Chak Sing CS Wong Ian Chi Kei ICK Chan Esther Wai Yin EWY
Annals of internal medicine 20230314 4
<h4>Background</h4>Whether hospitalized patients benefit from COVID-19 oral antivirals is uncertain.<h4>Objective</h4>To examine the real-world effectiveness of molnupiravir and nirmatrelvir-ritonavir in hospitalized patients with COVID-19 during the Omicron outbreak.<h4>Design</h4>Target trial emulation study.<h4>Setting</h4>Electronic health databases in Hong Kong.<h4>Participants</h4>The molnupiravir emulated trial included hospitalized patients with COVID-19 aged 18 years or older between 26 ...[more]