Non-randomized evaluation of hospitalization after a prescription for nirmatrelvir/ritonavir versus molnupiravir in high-risk COVID-19 outpatients

Abstract

Objectives To assess and compare subsequent hospital admissions within 30 days for patients after receiving a prescription for either oral nirmatrelvir/ritonavir or oral molnupiravir. Methods We conducted a retrospective review of 3207 high-risk, non-hospitalized adult COVID-19 patients who received a prescription for molnupiravir (n = 209) or nirmatrelvir/ritonavir (n = 2998) at an academic medical centre in New York City from April to December 2022. Variables including age, vaccination status, high-risk conditions and demographic factors were pulled from the electronic medical record. We used multivariable logistic regression to adjust for potential confounding variables. Results All-cause 30 day hospitalization was not significantly different between patients who received nirmatrelvir/ritonavir compared with molnupiravir (1.4% versus 1.9%, P value = 0.55). The association between COVID-related hospitalization and medication was also not significant (0.7%versus 0.5%, P value = 0.99). Patients who received molnupiravir were more likely to have more underlying high-risk conditions. After adjusting for potential confounders, the odds of all-cause hospitalizations were not significantly different between patients who received nirmatrelvir/ritonavir compared with molnupiravir (OR = 1.16, 95% CI: 0.4–3.3, P value = 0.79). Conclusions These data provide additional evidence to support molnupiravir as a suitable alternative when other COVID-19 antivirals cannot be given.

Comparison between available early antiviral treatments in outpatients with SARS-CoV-2 infection: a real-life study

“…Despite a younger median age, in a cohort of 145 fully vaccinated outpatients treated with MPV rates of hospital admission were similar, attesting at 2.7% [ 25 ]. Different real-life studies compared the efficacy of MPV and NTV/r in high-risk outpatients, founding similar results for both early antiviral treatments [ 9 , 26 ], pointing out that the choice of a specific antiviral drug over another is not the main variable able to influence the outcome of the patient. De Vito et al published a cohort of 192 patients with a mild disease treated with MPV [ 27 ], showing a progression rate of 10.4% despite a younger population (median 70 years).…”

“…Although MPV is no longer recommended in European countries, another large real-life study confirmed a favorable impact on COVID-related mortality even for such drug [ 8 ]. In addition, hospitalization rates of patients treated with MPV were similar to those treated with NTV/r, even if this latter group had lower underlying high-risk conditions [ 9 ].…”

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

“…Similarly, a real-life comparison cohort study of 17,977 patients sampled from the general population concluded that Paxlovid was superior to molnupiravir in reducing the risk of mortality by day 28, regardless of vaccination status and underlying comorbidities [72]. In contrast, in a retrospective review of 3207 high-risk COVID-19 outpatients, Paxlovid and molnupiravir produced similar results in reducing all-cause hospitalization rates [73].…”