BACKGROUND AND PURPOSE:

• Ritonavir-boosted nirmatrelvir (Paxlovid) and molnupiravir are prescribed to outpatients with mild-to-moderate COVID-19 who are at risk of progression to severe disease
• Lin et al. (JAMA Network Open, 2023) assessed the association of nirmatrelvir or molnupiravir use with the risks of hospitalization and death among patients infected with new Omicron subvariants

METHODS:

• Cohort study
• Population
  • Patients with COVID-19 between April 2022 and February 2023 who were at high risk of progressing to severe disease
  • During this period, Omicron variants evolved from BA.2 to BA.4/BA.5, then to BQ.1/BQ.1.1, and finally to XBB/XBB.1.5
• Exposures
  • Treatment with ritonavir-boosted nirmatrelvir or molnupiravir
• Study design
  • Follow-up through 90 days
  • The association of either nirmatrelvir or molnupiravir use with each outcome was measured by the hazard ratio (HR) adjusted for
    • Demographic factors | Socioeconomic status | Date of COVID-19 diagnosis | Coexisting medical conditions | COVID-19 vaccination status | Previous SARS-CoV-2 infection
• Primary outcome
  • Time to death
• Secondary outcome
  • Time to either hospitalization or death

RESULTS:

• 68,867 patients
  • Aged ≥65 years: 42.7% | Men: 38.9% | Non-Hispanic White: 42.7%
• Treatment with ritonavir-boosted nirmatrelvir or molnupiravir was associated with a reduction in deaths
  • Nirmatrelvir: aHR 0.16 (95% CI, 0.11 to 0.23)
  • Molnupiravir: aHR 0.23 (95% CI, 0.16 to 0.34)
• Treatment was also associated with a reduction in hospitalizations or death
  • Nirmatrelvir: aHR 0.63 (95% CI, 0.59 to 0.68)
  • Molnupiravir: aHR 0.59 (95% CI, 0.53 to 0.66)
• These associations were observed across subgroups
  • Age | Race and ethnicity | Date of COVID-19 diagnosis | Vaccination status | Previous infection status | Coexisting conditions

CONCLUSION:

• Ritonavir-boosted nirmatrelvir or molnupiravir are associated with a reduction in deaths and hospitalizations in patients with Omicron variants of SARS-CoV-2
• This benefit of treatment existed regardless of age, race and ethnicity, virus strain, vaccination status, previous infection status, or coexisting condition
• The authors state

Both drugs can, therefore, be used to treat nonhospitalized patients who are at high risk of progressing to severe COVID-19

Learn More – Primary Sources:

Nirmatrelvir or Molnupiravir Use and Severe Outcomes From Omicron Infections