For improving 30-day outcomes among U.S. veterans with COVID-19, ritonavir-boosted nirmatrelvir reduced both hospitalizations and mortality, while molnupiravir reduced mortality but not hospitalizations, researchers report. From 31 to 180 days, mortality was reduced further with both antiviral agents.
Nonhospitalized veterans at risk for severe COVID-19 who tested positive in Jan. through July 2022 were included in 3 retrospective studies. Matched cohorts compared outcomes with nirmatrelvir–ritonavir versus no treatment, molnupiravir versus no treatment, and nirmatrelvir–ritonavir versus molnupiravir.
Based on the incidence of any hospitalization or all-cause mortality at 30 days and from 31 to 180 days, the analyses showed: “Eighty-seven percent of participants were male; the median age was 66 years, and 18% were unvaccinated. Compared with matched untreated control participants, those treated with nirmatrelvir–ritonavir (n = 9,607) had lower 30-day risk for hospitalization (22.07 vs. 30.32 per 1,000 participants; risk difference [RD], −8.25 [95% CI, −12.27 to −4.23] per 1,000 participants) and death (1.25 vs. 5.47 per 1,000 participants; RD, −4.22 [CI, −5.45 to −3.00] per 1,000 participants). Among persons alive at day 31, reductions were seen in 31- to 180-day incidence of death (hazard ratio, 0.66 [CI, 0.49 to 0.89]) but not hospitalization (subhazard ratio, 0.90 [CI, 0.79 to 1.02]). Molnupiravir-treated participants (n = 3,504) had lower 30-day and 31- to 180-day risks for death (3.14 vs. 13.56 per 1,000 participants at 30 days; RD, −10.42 [CI, −13.49 to −7.35] per 1,000 participants; hazard ratio at 31 to 180 days, 0.67 [CI, 0.48 to 0.95]) but not hospitalization. A difference in 30-day or 31- to 180-day risk for hospitalization or death was not observed between matched nirmatrelvir- or molnupiravir-treated participants.”