Among COVID-19 patients with Asthma: Paxlovid recipients had lower Hospitalization Risk compared to Molnupiravir: Study

Key Findings

• Patients who received nirmatrelvir/ritonavir had a 73% reduced risk of acute inpatient death (HR 0.27; 95% CI, 0.12 to 0.59; p = 0.0011).

• Risk of post-acute inpatient death was 51% reduced in the nirmatrelvir/ritonavir group (HR 0.49; 95% CI, 0.28 to 0.85; p = 0.011).

• All-cause hospitalization was reduced significantly in the nirmatrelvir/ritonavir group (HR 0.72; 95% CI, 0.58 to 0.89; p = 0.0020).

• Risk of myocardial infarction (heart attack) was 90% less in the nirmatrelvir/ritonavir arm (HR 0.10; 95% CI, 0.01 to 0.92; p = 0.042).

• In head-to-head comparisons with molnupiravir, risk of all-cause hospitalization was 35% less in the nirmatrelvir/ritonavir arm (HR 0.65; 95% CI, 0.52 to 0.81; p = 0.00012).

• In patients on medium-/high-dose inhaled corticosteroids, the nirmatrelvir/ritonavir arm had a 42% reduction in risk of asthma exacerbation compared with the molnupiravir group (HR 0.58; 95% CI, 0.35 to 0.95; p = 0.030).

The study authors concluded that nirmatrelvir/ritonavir decreases post-acute COVID-19 complications among asthma patients, decreasing mortality, hospitalization, and rates of asthma exacerbation when compared to molnupiravir. These results indicate that clinical guidelines need to expand antiviral treatment indications to mild asthma patients, who have not yet been well acknowledged as priority patients for COVID-19 antiviral therapy.

Reference:

Lin, G., Wei, Y., Guo, Z. et al. Short- and long-term comparative effectiveness of nirmatrelvir/ritonavir and molnupiravir in asthma patients: a cohort study. Respir Res 26, 75 (2025). https://doi.org/10.1186/s12931-025-03156-2