Clinical effectiveness of molnupiravir in patients with COVID-19 undergoing haemodialysis

Chang, Yi-Chin; Chen, Yi‐Chun; Huang, Chiang-Chi; Fu, Chung-Ming; Lee, Yueh‐Ting; Wu, Po-Jung; Lee, Wen‐Chin; Lee, Chien-Te; Liao, Shang-Chih; Tsai, Kai-Fan

doi:10.1016/j.ijantimicag.2023.106834

Cited by 8 publications

(4 citation statements)

References 30 publications

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“…This retrospective study also focused on some vulnerable populations such as solid organ transplant recipients and immunocompromised patients (including hematological cancers and other malignant tumors). Previous studies found that antiviral drugs can accelerated the virus clearance and improved the prognosis on solid organ transplant recipients and patients undergoing hemodialysis with COVID-19 [19,20]. Perhaps due to the small number of patients analyzed, the study results did not show that Azvudine had a protective effect in organ transplant recipients or immunocompromised patients.…”

Section: Discussionmentioning

confidence: 65%

Effectiveness and Optimal Timing of Azvudine in COVID-19 Patients: A Multi-center Retrospective Study in Beijing, China

Han

Xiao

Wang

et al. 2023

Preprint

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Background: Clinical effectiveness of Azvudine against coronavirus infection and optimal time for initiation of Azvudine treatment to hospitalized COVID-19 patients are not fully understood. Methods: This is a multi-center retrospective cohort study, and five clinical centers of the Chinese People’s Liberation Army General Hospital participated. From omicron pandemics, 6218 hospitalized patients confirmed with COVID-19 from December 10, 2022, to February 20, 2023, were retrieved for this study. After exclusions and propensity score matching , 428 Azvudine recipients and 428 controls were included with a follow-up of 28 days. The primary outcome was all-cause mortality during 28 days of hospitalization, and the secondary outcome was the proportion of patients with clinical improvement up to day 28. Results: The Azvudine group had a lower crude all-cause death rate when compared to the control group (2.82 per 1000 person-days vs. 4.52 per 1000 person-days; HR: 0.63, 95%CI: 0.40-1.00; P=0.038). Notably, the incidence rate of clinical improvement outcome was significantly higher in patients who received Azvudine within 5 days from the onset of symptoms, compared to the control group (Median days: 9 vs. 10; P=0.007). Subgroup analyses showed that chronic lung disease and corticosteroid treatment acted as protective factors (P=0.010; P=0.050). Conclusions: Clinical effectiveness of Azvudine in improving all-cause mortality in COVID-19 patients was seen, and initiation of Azvudine treatment within 5 days of the onset of symptoms was found to be significant. Additionally, the findings revealed the protective effect of Azvudine in COVID-19 patients with chronic lung disease.

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Section: Discussionmentioning

confidence: 65%

Effectiveness and Optimal Timing of Azvudine in COVID-19 Patients: A Multi-center Retrospective Study in Beijing, China

Han

Xiao

Wang

et al. 2023

Preprint

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“…Oral COVID-19 medication use was associated with the lower risk of severe COVID-19 events, consistent with previous reports. 10 , 11 In a retrospective study of 225 patients requiring hemodialysis with initially mild or asymptomatic COVID-19, molnupiravir use was associated with a marked reduction in the 30-day risk of COVID-19–related acute care visits (hazard ratio 0.22, 95% CI [0.07 to 0.64]). 10 Another study tracked a composite of all-cause mortality, intensive care unit admission, or cardiovascular events in 73 patients with CKD treated with nirmatrelvir/ritonavir (19 of whom were receiving maintenance dialysis) compared with 122 patients (43 of whom were receiving maintenance dialysis) who did not receive this agent.…”

Section: Discussionmentioning

confidence: 99%

“… 10 , 11 In a retrospective study of 225 patients requiring hemodialysis with initially mild or asymptomatic COVID-19, molnupiravir use was associated with a marked reduction in the 30-day risk of COVID-19–related acute care visits (hazard ratio 0.22, 95% CI [0.07 to 0.64]). 10 Another study tracked a composite of all-cause mortality, intensive care unit admission, or cardiovascular events in 73 patients with CKD treated with nirmatrelvir/ritonavir (19 of whom were receiving maintenance dialysis) compared with 122 patients (43 of whom were receiving maintenance dialysis) who did not receive this agent. 11 Treated patients had fewer composite events (adjusted HR 0.56 [95% CI, 0.32 to 0.96]), experienced a shorter duration of viral shedding (adjusted HR, 3·70 [95% CI, 2.60 to 5.28]), and demonstrated faster viral load clearance.…”

Section: Discussionmentioning

confidence: 99%

Oral Agents and SARS-CoV-2 Vaccine Effectiveness against Severe COVID-19 Omicron Events in Patients Requiring Maintenance Dialysis

Manley,

Li,

Hsu

et al. 2024

Kidney360

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“…NHC is not eliminated through renal clearance, and some studies have shown the favorable adverse effect profile and clinical efficacy of molnupiravir at a standard dosage of 800 mg twice daily for five days in patients with COVID-19 and advanced CKD or undergoing hemodialysis [93,94]. A retrospective cohort study in adult hospitalized patients with COVID-19 and chronic kidney disease with eGFR ≥ 30 mL/min/1.73 m 2 revealed that early initiation of Paxlovid was associated with reduced rates of all-cause death, invasive ventilation and ICU admission [95].…”

Section: Patients With Severe Chronic Kidney Disease (Ckd)mentioning

confidence: 99%

Oral Molnupiravir and Nirmatrelvir/Ritonavir for the Treatment of COVID-19: A Literature Review with a Focus on Real-World Evidence

Karniadakis,

Mazonakis,

Tsioutis

et al. 2023

Infectious Disease Reports

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Vaccines remain the cornerstone of medical prevention and are highly effective in reducing the risk of severe disease and death due to coronavirus disease 2019 (COVID-19). In the context of expanding the therapeutic armamentarium against COVID-19, molnupiravir (Lagevrio) and ritonavir-boosted nirmatrelvir (Paxlovid) were developed, constituting the first effective oral treatments against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this narrative review, we retrospectively inquired into the clinical trials and real-world studies investigating the efficacy of these agents. Overall, clinical trials and real-world studies have demonstrated the efficacy of both agents in reducing hospitalization and death rates in COVID-19 patients. As per current recommendations, their use is suggested in patients with mild to moderate symptoms who are at high risk of developing severe disease. Nevertheless, limited data exist regarding their efficacy in specific subpopulations, such as immunocompromised patients, those with severe kidney disease, pregnant women, and children.

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Clinical effectiveness of molnupiravir in patients with COVID-19 undergoing haemodialysis

Cited by 8 publications

References 30 publications

Effectiveness and Optimal Timing of Azvudine in COVID-19 Patients: A Multi-center Retrospective Study in Beijing, China

Effectiveness and Optimal Timing of Azvudine in COVID-19 Patients: A Multi-center Retrospective Study in Beijing, China

Oral Agents and SARS-CoV-2 Vaccine Effectiveness against Severe COVID-19 Omicron Events in Patients Requiring Maintenance Dialysis

Oral Molnupiravir and Nirmatrelvir/Ritonavir for the Treatment of COVID-19: A Literature Review with a Focus on Real-World Evidence

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