Among COVID-19 patients with Asthma: Paxlovid recipients had lower Hospitalization Risk compared to Molnupiravir
Researchers have found in a new study that among COVID-19 patients with asthma, those who received Paxlovid had a significantly lower risk of all-cause hospitalization compared to those treated with molnupiravir. Although COVID-19 antiviral drugs have been extensively researched, their efficacy among asthma patients is uncertain.
Based on real-world data from Hong Kong health officials, the results indicate that nirmatrelvir/ritonavir reduces mortality, hospitalization, and asthma exacerbations, in patients with asthma. The study was conducted by Guozhang and colleagues published in BMC Respiratory Research.
This study consisted of 1,745 adults with asthma diagnosed with COVID-19 from March 16, 2022, to October 30, 2023. Patients included in the research had a past history of asthma and were taking asthma medications. The research was between nirmatrelvir/ritonavir and molnupiravir treatment groups and assessed acute and post-acute mortality, all-cause hospitalization, and cause-specific hospitalizations. Median follow-up duration was 365 days (IQR: 335–365 days).
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
