In 2 emulation studies using electronic health databases in Hong Kong, hospitalized patients with COVID-19 had lower rates of all-cause mortality when treated with molnupiravir or ritonavir-boosted nirmatrelvir compared with no oral antiviral agents, researchers report. The positive findings held in patients regardless of vaccination status; rates of ICU admission or ventilatory support were not different between the groups.
The studies included hospitalized adult patients with COVID-19 from late winter to mid-July 2022. Patients started on 1 of the drugs within the first 5 days of hospitalization were compared with patients who did not receive either agent. Based on effectiveness against all-cause mortality, ICU admission, and ventilatory support, the authors report these 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.”