Paxlovid and Molnupiravir Reduce Mortality and Hospitalisation in High-Risk Omicron-Infected Patients

Ritonavir-boosted Nirmatrelvir and Molnupiravir, two oral antiviral drugs currently used to treat nonhospitalized COVID-19 patients at high risk of progressing to severe disease, have not been extensively studied for their effectiveness against new SARS-CoV-2 Omicron sub variants, particularly BQ.1.1 and XBB.1.5. To address this, a cohort study published in JAMA Network Open by Dan-Yu Lin and colleagues was conducted among COVID-19 patients diagnosed at the Cleveland Clinic between April 1, 2022, and February 20, 2023. These patients were assessed for high-risk factors and followed up for 90 days after diagnosis as the Omicron variant evolved through various sub variants.

• The study included 68,867 patients, with a significant proportion aged 65 or older (42.7%) and male patients (38.9%). Among them, 30 out of 22,594 patients treated with nirmatrelvir, 27 out of 5,311 patients treated with molnupiravir, and 588 out of 40,962 patients who received no treatment died within 90 days of Omicron infection.
  
• After adjusting for various factors, the hazard ratios (HRs) for death were 0.16 (95% CI, 0.11-0.23) for nirmatrelvir and 0.23 (95% CI, 0.16-0.34) for molnupiravir.
• Additionally, the adjusted HRs for hospitalisation or death were 0.63 (95% CI, 0.59-0.68) for nirmatrelvir and 0.59 (95% CI, 0.53-0.66) for molnupiravir.
• These positive associations with reduced mortality and hospitalisation were consistent across various patient subgroups, including age, race and ethnicity, virus strain, vaccination status, previous infection status, and coexisting conditions.

This study concludes that nirmatrelvir and molnupiravir are associated with significant reductions in mortality and hospitalisation among nonhospitalized COVID-19 patients infected with Omicron, regardless of age, race, virus strain, vaccination status, previous infection, or coexisting conditions. These drugs are effective treatments for high-risk COVID-19 patients and can aid in preventing severe disease outcomes.

Reference:

Lin, D.-Y., Abi Fadel, F., Huang, S., Milinovich, A. T., Sacha, G. L., Bartley, P., Duggal, A., & Wang, X. Nirmatrelvir or molnupiravir use and severe outcomes from Omicron infections. JAMA Network Open,2023;6(9),e2335077. https://doi.org/10.1001/jamanetworkopen.2023.35077