The effectiveness of novel oral antiviral treatment for non-hospitalized high-risk patients with COVID-19 during predominance of omicron XBB subvariants

ABSTRACT

Objectives

This study investigated the association between nirmatrelvir plus ritonavir (NMV-r) or molnupiravir and the outcomes of non-hospitalized high-risk patients with COVID-19 during Omicron XBB subvariants.

Methods

The retrospective cohort study used the TriNetX US collaborative network to identify non-hospitalized high-risk adult patients with COVID-19 between 1 February 2023, and 31 August 2023. Propensity score matching (PSM) was used to match patients receiving NMV-r or MOV (the study group) with those not receiving antivirals (the control group).

Results

Using PSM, two cohorts of 17,654 patients each with balanced baseline characteristics were identified. During the follow-up period, the study group had a lower risk of all-cause hospitalization, or death (3.2% [n = 564] versus 3.8% [n = 669]; HR, 0.796; 95% confidence interval [CI], 95% CI, 0.712–0.891). Compared with the control group, the study group had a significantly lower risk of all-cause hospitalization (3.1% vs. 3.4%; HR, 0.847; 95% CI, 0.754–0.950) and mortality (0.1% vs. 0.4%; HR, 0.295; 95% CI, 0.183–0.476).

Conclusion

The use of novel oral antiviral including NMV-r or MOV can be associated with a lower risk of all-cause hospitalization, or death in non-hospitalized high-risk patients with COVID-19 during Omicron XBB wave.

KEYWORDS:

• COVID-19
• hospitalization
• mortality
• nirmatrelvir plus ritonavir
• molnupiravir
• SARS-CoV-2

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethics

This study was approved by the Institutional Review Board of Chi Mei Medical Center (approval number 11,202–002).

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Author contribution

Conception: Chi-Kuei Hsu, Chih‐Cheng Lai. Study design: Chi-Kuei Hsu, Wan-Hsuan Hsu, Bo-Wen Shiau, Chih-Cheng Lai. Analysis and interpretation: Wan-Hsuan Hsu, Bo-Wen Shiau, Ya-Wen Tsai, Jheng-Yan Wu, Ting-Hui Liu, Po-Yu Huang, Min-Hsiang Chuang. Drafted or written: Chi-Kuei Hsu, Wan-Hsuan Hsu. Substantially revised or critically review: Chih‐Cheng Lai.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14787210.2024.2339398

Additional information

Funding

This paper was not funded.