Clinical effectiveness of oral antiviral agents for treating non-hospitalized COVID-19 patients with chronic kidney disease

ABSTRACT

Objectives

This study examined the effectiveness of nirmatrelvir plus ritonavir (NMV-r) and molnupiravir (MOV) in treating COVID-19 among chronic kidney disease (CKD) patients.

Methods

This retrospective cohort study, using the TriNetX research network, identified stage 3–5 CKD and end-stage kidney disease (ESKD) patients with non-hospitalized COVID-19 between 1 January 2022, and 31 May 2023. Propensity score matching (PSM) was used to compare patients on NMV-r or MOV (antiviral group) against those not receiving these treatments (control group). The primary composite outcome was the cumulative hazard ratio (HR) for all-cause hospitalization or death within the 30-day follow-up.

Results

After PSM, two balanced cohorts of 6,275 patients each were established. The antiviral group exhibited a lower incidence of all-cause hospitalization or mortality (5.93% vs. 9.53%; HR: 0.626; 95% CI: 0.550–0.713) than controls. Additionally, antiviral recipients were associated with a lower risk of all-cause hospitalization (HR: 0.679; 95% CI: 0.594–0.777) and mortality (HR: 0.338; 95% CI: 0.227–0.504). The beneficial effects of antiviral agents were consistent across sex, age, vaccination status, antiviral type, and CKD stage.

Conclusion

Oral antiviral agents could be associated with lower rates of all-cause hospitalization or death among non-hospitalized COVID-19 patients with CKD.

KEYWORDS:

• COVID-19
• hospitalization
• mortality
• nirmatrelvir plus ritonavir
• chronic kidney disease
• 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

The study was conducted in accordance with the Declaration of Helsinki and was approved by the ethics committee of Chi Mei Medical Center (approval number: 11202–002).

Data availability statement

As an HCO member of TriNetX, Chi Mei Medical Center has access to the de-identified data in TriNetX. All data related to this study have been presented in the article.

Author contributions

All authors contributed to this study. Chia-Chen Chen, Chi-Ya Huang, Jheng-Yan Wu, I-Ning Yang, and Chih-Cheng Lai contributed to the conception and design of the study and drafted the manuscript. Chia-Chen Chen, Chi-Ya Huang, Jheng-Yan Wu, Mei-Yuan Liu, Min-Hsiang Chuang, I-Ning Yang, and Chih-Cheng Lai contributed to the acquisition, analysis and interpretation of data. Ting-Hui Liu, Ya-Wen Tsai, Wan-Hsuan Hsu, Po-Yu Huang, Ming-Hui Chen, Su-Yen Liu, Mei-Chuan Lee, and Kuo-Chuan Hung revised the manuscript. All authors gave final approval for this manuscript and are accountable for the study’s integrity and accuracy.

Additional information

Funding

This paper was not funded.