Characteristics and outcomes of US Veterans at least 65 years of age at high risk of severe SARS-CoV-2 infection with or without receipt of oral antiviral agents

Real-World Study on Effectiveness of Molnupiravir and Nirmatrelvir–Ritonavir in Unvaccinated Patients with Chronic Respiratory Diseases with Confirmed SARS-CoV-2 Infection Managed in Out-Patient Setting

“…A real-world study in Italy suggested both NMV-r and MOV to be effective, while patients treated with NMV-r had lower risk of hospitalizations and earlier recovery, though the age, body mass index and underlying co-morbidities differed in the NMV-r and MOV groups, as in our study as well as other real-world studies [ 21 ]. In a recent retrospective, observational, nationwide propensity-matched analysis comparing outcomes of US veterans 65 years and older with mild-to-moderate COVID-19, the composite primary outcome of admission or death within 30 days of diagnosis was reached less often in those receiving either MOV or NMV-r versus those that received no antiviral, while NMV-r was more effective than MOV in both outcomes [ 22 ]. The composite outcome of death or hospitalization was shown to be lower in NMV-r treated patients than MOV treated subjects in another study, but the difference in the degree of underlying co-morbidity could contribute to the difference [ 23 ].…”

“…Most of the published literature on the efficacy of NMV-r and MOV has focused on the whole population [ 5 , 6 , 21 ]. There have also been studies on selected patient subgroups including all COVID-19 subjects at high risk of progression [ 23 ], elderly populations [ 22 , 25 ], hematology patients [ 26 ] and solid organ transplant recipients [ 27 ]. However, there has not been any dedicated study focusing on patients with chronic respiratory disease, who are prone to developing severe COVID-19.…”

Clinical effectiveness of oral antiviral agents in older patients with COVID‐19 based on real‐world data

“…In this study, we found that oral antiviral agents are associated with a low risk of all‐cause hospitalization in the vaccinated older patient subgroup, this difference did not reach statistical significance (HR, 0.506; 95% CI, 0.402–0.637). This finding is different from that of a previous study 24 . Gentry et al conducted a subgroup analysis of older patients who completed the first booster vaccination and reported that, compared with the untreated patients, those who received oral antiviral agents had a lower risk of admission (3.1% vs. 5%; p = 0.1) 24 .…”

“…These findings are consistent with those of previous studies 16,23–25 . A retrospective, observational, nationwide propensity‐matched analysis involving 2740 US Veterans aged ≥65 years revealed that, compared with the untreated patients, those who received NMV‐r or MOV had lower risk of admission or death within 30 days of diagnosis (65/1370 [4.75%] vs. 139/1370 [10.2%]; odds ratio, 0.44; 95% CI, 0.32–0.60; p < 0.0001) 24 .…”

“…These findings are consistent with those of previous studies 16,23–25 . A retrospective, observational, nationwide propensity‐matched analysis involving 2740 US Veterans aged ≥65 years revealed that, compared with the untreated patients, those who received NMV‐r or MOV had lower risk of admission or death within 30 days of diagnosis (65/1370 [4.75%] vs. 139/1370 [10.2%]; odds ratio, 0.44; 95% CI, 0.32–0.60; p < 0.0001) 24 . Similarly, subgroup analysis of 268 patients aged ≥ 65 years in the Evaluation of Protease Inhibition for COVID‐19 in High‐Risk Patients trial revealed that the use of NMV‐r is associated with a reduced risk of COVID‐19‐related hospitalization or all‐cause death through Day 28 compared with those receiving placebo (1/131 vs. 20/137) 16 .…”