Effectiveness of recently-approved oral antiviral medications on the outcome of patients with mild-to-moderate COVID-19 and pre–existing chronic obstructive pulmonary diseases

ABSTRACT

Objectives

This study assessed the effectiveness of the oral antiviral agents nirmatrelvir – ritonavir (NMV-r) and molnupiravir (MOV) for treating mild-to-moderate coronavirus disease 2019 (COVID-19) in patients with COPD.

Methods

This retrospective cohort study extracted data from the TriNetX platform and examined 94,984 COVID-19 patients with preexisting COPD from 1 January 2022, to 1 October 2023. Patients receiving NMV-r or MOV (study group) were compared with those not receiving oral antiviral agents (control group) after propensity score matching (PSM).

Results

After PSM, 7,944 patients were classified into the study and control groups. The primary composite outcome of all-cause hospitalization, or death in 30 days was reported in 458 (5.7%) patients in the study group and 566 (7.1%) patients in the control cohort, yielding a hazard ratio [HR] of 0.79 (95% confidence interval [CI]: 0.70–0.89; Table 2). Compared with the control group, the study group had a significantly lower risk of all-cause hospitalization (HR, 0.87; 95% CI: 0.76–0.99) and death (HR: 0.21, 95% CI: 0.13–0.35).

Conclusions

This study revealed that oral antivirals – NMV-r or MOV might improve clinical outcomes in patients with preexisting COPD and COVID-19. However, only a small proportion of preexisting COPD patients with COVID-19 received oral antiviral treatment.

KEYWORDS:

• Chronic obstructive pulmonary disease
• coronavirus disease 2019
• nirmatrelvir–ritonavir
• molnupiravir
• severe acute respiratory syndrome coronavirus 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 statement

This study was approved by the Institutional Review Board of Chi Mei Medical Center (No. 11202–002).

Data availability statement

The datasets generated or analyzed during the current study are available from the corresponding author upon reasonable request.

Author contributions

Ting-Hui Liu contributed the idea, designed the study, and did the primary writing. Jheng-Yan Wu, Po-Yu Huang, Wan-Hsuan Hsu, and Min-Hsiang Chuang were responsible for statistics and methodology. Ya-Wen Tsai provided expertise in databases. Chih-Cheng Lai and Charles Lung-Cheng Huang supervised and revised the article.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14787210.2024.2351571.

Additional information

Funding

This paper was not funded.