The effect of molnupiravir on post-acute outcome of COVID-19 survivors

Effectiveness of nirmatrelvir/ritonavir and molnupiravir on post-COVID-19 outcomes among outpatients: a target trial emulation investigation

Limited studies compared the effectiveness of nirmatrelvir/ritonavir and molnupiravir against a control group on post-COVID-19 conditions. Our study examined the association of nirmatrelvir/ritonavir and molnupiravir with post-acute mortality and hospitalizations among outpatients using real-world outpatient records of COVID-19 designated clinics in Hong Kong. This is an observational study using a target trial emulation framework, involving nirmatrelvir-ritonavir versus no antiviral treatment (Trial 1) and molnupiravir versus no antiviral treatment (Trial 2). Outcomes included post-acute mortality, all-cause hospitalization, and hospitalization due to 13 selected sequelae. Relative effectiveness was assessed by comparing the cumulative incidence between two groups, reported as relative risk (RR), along with risk differences (RD) during day 0-30, 31-180, and 181-360. After screening, 140,477 and 96,030 patients were included in Trial 1 and 2, respectively. Compared with no treatment, nirmatrelvir/ritonavir-treated patients exhibited a significantly lower risk of post-acute mortality (31-180 days: RR, 0.71; 95% CI, 0.54-0.96; RD, 0.20%; 181-360 days: RR, 0.64; 95% CI, 0.50-0.82; RD, 0.32%) and all-cause hospitalization (31-180 days: RR, 0.82; 95% CI, 0.76-0.88; RD, 1.11%; 181-360 days: RR, 0.83; 95% CI, 0.78-0.89; RD, 1.18%). Patients receiving molnupiravir had a lower risk of 30-day mortality, but no significant beneficial effect was observed for the post-acute outcomes. In conclusion, this study demonstrated the effectiveness of nirmatrelvir/ritonavir in reducing post-COVID-19 outcomes among outpatients. While we observed the short-term effectiveness of molnupiravir in reducing mortality, no protective effect on long-term post-COVID-19 outcomes was observed.

Clinical effectiveness of oral antiviral treatment for non-hospitalized high-risk patients with COVID-19 during Omicron JN.1 subvariant wave: a US-based propensity-matched cohort study

BACKGROUND

This real-world study aimed to assess the effectiveness of novel oral antiviral agents in managing COVID-19 among high-risk patients during the Omicron JN.1 subvariant wave.

METHODS

Data from the TriNetX US network were analyzed using a multi-institutional propensity score matching (PSM) analysis. High-risk non-hospitalized adults with COVID-19 were included, and patients receiving oral antiviral agents (study group) were compared to those not receiving antiviral agents (control group). Primary outcomes included all-cause emergency department (ED) visits, hospitalizations, or death within 30 days.

RESULTS

Among 67,495 high-risk patients identified, 17,852 received oral antiviral agents (study group) and 49,643 did not (control group). After PSM, two matched cohorts of 17,847 patients each were established. The study group receiving antiviral agents exhibited a significantly lower risk of primary composite outcome during the 30-day follow-up period compared to the control group (HR, 0.77; 95% CI, 0.72-0.84). Regarding the secondary outcomes, the study group consistently exhibited a significantly lower risk of all-cause ED visits (4.2% vs. 5.4%; HR, 0.78; 95% CI, 0.71-0.86), hospitalization (2.8% vs. 3.3%; HR, 0.86; 95% CI, 0.77-0.97), and mortality (0.1% vs. 0.3%; HR, 0.17; 95% CI, 0.08-0.35) than the control group. Subgroup analyses showed consistent benefits across various demographic and clinical characteristics, except in individuals with booster vaccination.

CONCLUSIONS

Oral antiviral agents significantly reduced the risk of adverse outcomes among high-risk COVID-19 patients during the Omicron JN.1 subvariant wave. These findings support the potential benefits of oral antiviral therapy in treating COVID-19, particularly in high-risk populations.

Outcomes of non-hospitalized patients with COVID-19 versus seasonal influenza during the fall-winter 2022-2023 period

BACKGROUND

The comparability of outcomes for non-hospitalized COVID-19 outpatients during the Omicron wave to outpatients with influenza remains uncertain. This study aims to compare the outcomes of non-hospitalized outpatients with COVID-19 and seasonal influenza during the fall-winter of 2022-2023.

METHODS

This is a retrospective cohort study using TriNetX, a collaborative clinical research platform. Non-hospitalized outpatients with COVID-19 and seasonal influenza between 01 October 2022 and 31 January 2023 were selected from TriNetX. Propensity score matching (PSM) was used to compare patients receiving corresponding outpatient antiviral treatments. Hazard ratios (HRs) with 95% confidence intervals (CIs) for the primary outcome-a composite of all-cause emergency department (ED) visits, hospitalizations, or mortality during the 30-day follow-up period-were calculated and compared.

RESULTS

After PSM, two well-balanced groups of 9,030 patients each were identified. Non-hospitalized COVID-19 patients had a lower risk of primary composites outcomes including all-cause ED visits, hospitalization, or mortality (5.9% vs. 9.2%, HR, 0.661[95% CI, 0.593-0.737]) compared to the influenza group. In addition, the COVID-19 group demonstrated a reduced risk of all-cause ED visits (4.4% vs. 6.6%, HR 0.683[0.601-0.776]), hospitalization (1.7% vs. 2.9%, HR 0.605[0.495-0.739]) and mortality (0.1% vs. 0.2%, HR 0.176[0.052-0.597]), respectively.

CONCLUSIONS

This study indicates a lower risk of all-cause ED visits, hospitalization, and mortality in the non-hospitalized COVID-19 patients compared to the seasonal influenza group, supporting the current public health strategy of adjusting COVID-19 management based on approaches used for seasonal influenza.

Learning from post-COVID-19 condition for epidemic preparedness: a variable catalogue for future post-acute infection syndromes

SCOPE

The emergence of post-COVID-19 condition (PCC) after SARS-CoV-2 infection underscores the critical need for preparedness in addressing future post-acute infection syndromes (PAIS), particularly those linked to epidemic outbreaks. The lack of standardized clinical and epidemiological data during the COVID-19 pandemic has significantly hindered timely diagnosis and effective treatment of PCC, highlighting the necessity of pre-emptively standardizing data collection in clinical studies to better define and manage future PAIS. In response, the Cohort Coordination Board, a consortium of European-funded COVID-19 research projects, has reviewed data from PCC studies conducted by its members. This paper leverages the Cohort Coordination Board's expertise to propose a standardized catalogue of variables, informed by the lessons learned during the pandemic, intended for immediate use in the design of future observational studies and clinical trials for emerging infections of epidemic potential.

RECOMMENDATIONS

The early implementation of standardized data collection, facilitated by the PAIS data catalogue, is essential for accelerating the identification and management of PAIS in future epidemics. This approach will enable more precise syndrome definitions, expedite diagnostic processes, and optimize treatment strategies, while also supporting long-term follow-up of affected individuals. The availability of harmonized data collection protocols will enhance preparedness across European and international cohort studies, and trials enabling a prompt and coordinated response, as well as more efficient resource allocation, in the event of emerging infections and associated PAIS.

Clinical effectiveness of oral antivirals for non-hospitalized adult COVID-19 patients aged 18-60 years

OBJECTIVE

To investigate the effectiveness of oral antiviral agents - nirmatrelvir - ritonavir or molnupiravir in non-hospitalized COVID-19 patients aged < 60 years.

METHODS

This retrospective cohort study analyzed data of patients aged 18-60 years diagnosed with COVID-19 between 1 January 2022, and 30 June 2023. Propensity score matching was used to balance the demographic and clinical characteristics of patients receiving oral antivirals (nirmatrelvir - ritonavir or molnupiravir) and untreated controls. The primary outcome was a composite of all-cause emergency department visits, hospitalizations, or mortality within 30 days. The secondary outcomes included each individual component of the primary composite outcome.

RESULTS

Two matched cohorts (antiviral group and control group) comprising 52,585 patients with balanced baseline characteristics were created using propensity score-matching. During follow-up period, the antiviral group demonstrated a lower risk of the primary outcome than the control group (hazard ratio [HR] 0.772, 95% confidence interval [CI] 0.736-0.808, p < 0.001). The antiviral group also exhibited a reduced risk of individual secondary outcomes, including emergency department visits (HR 0.780, 95% CI, 0.738-0.825), hospitalization (HR 0.755, 95% CI, 0.715-0.840), and mortality (HR 0.297, 95% CI, 0.147-0.600).

CONCLUSION

Oral antiviral agents were associated with lower risks of all-cause emergency department visits, hospitalizations, and mortality in non-hospitalized COVID-19 patients aged < 60 years.

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

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.

Effectiveness of molnupiravir for treating COVID-19 in patients with psychiatric disorders

Objectives

This study investigated the clinical effectiveness of molnupiravir for treating non-hospitalized COVID-19 patients with pre-existing psychiatric disorder.

Methods

This retrospective cohort study used the TriNetX research network to identify patients with psychiatric disorder who experienced non-hospitalized COVID-19 between 1 January 2022, and 1 May 2023. The propensity score matching (PSM) method was used to match patients receiving molnupiravir (treated group) with those who did not (untreated group). The outcome included short-term outcomes - the composite of all-cause hospitalization or death within 30 days and the risk of post-COVID-19 conditions up to a year after COVID-19 diagnosis.

Results

Two groups of 9,421 patients, each with balanced baseline characteristics, were identified using the PSM method. During the 30-day follow-up, treated group was associated with a reduced risk of hospitalization or mortality compared to untreated group (HR, 0.760; 95% CI, 0.665-0.869). Compared to untreated group, treated group also exhibited a decreased risk of experiencing post-COVID-19 conditions, including chest/throat pain (HR, 0.615; 95% CI, 0.543-0.696), abnormal breathing (HR, 0.761; 95% CI, 0.687-0.884), abdominal symptoms (HR, 0.748; 95% CI, 0.674-0.831), fatigue (HR, 0.718; 95% CI, 0.638-0.808), headache (HR, 0.753; 95% CI, 0.665-0.852), cognitive symptoms (HR, 0.769; 95% CI, 0.630-0.940), myalgia (HR, 0.647; 95% CI, 0.530-0.789), cough (HR, 0.867; 95% CI, 0.770-0.978), and palpitation (HR, 0.641; 95% CI, 0.534-0.770) during the 1-year follow-up.

Conclusion

Molnupiravir could be associated with lower rates of all-cause hospitalization or death and also lower risk of post-COVID-19 condition among non-hospitalized COVID-19 patients with pre-existing psychiatric disorder.

Comparison of post-acute sequelae following hospitalization for COVID-19 and influenza

BACKGROUND

Few studies have directly compared the risk and magnitude of post-acute sequelae following COVID-19 and influenza, and most of these studies were conducted before emergence of the Omicron. This study investigated the prevalence of post-COVID conditions and the long-term risk of emergency department (ED) visits, hospitalizations, and deaths in patients with COVID-19 and compared their risk with that of patients with influenza.

METHODS

A retrospective study based on the TriNetX databases, a global health research network. We identified patients with COVID-19 and influenza who required hospitalization between January 1, 2022, and January 1, 2023. We compared the risk of developing any post-COVID conditions between the two groups and also analyzed each post-COVID-19 condition and all-cause ED visits, hospitalizations, and deaths in both populations during the follow-up 90-180 days.

RESULTS

Before matching, 7,187 patients with COVID-19 were older (63.9 ± 16.7 vs. 55.4 ± 21.2) and were predominantly male (54.0% vs. 45.4%), and overweight/obese (16.1% vs. 11.2%) than 11,266 individuals with influenza. After propensity score matching, 6,614 patients were identified in each group, resulting in well-balanced baseline characteristics. During follow-up, the COVID-19 group had a higher incidence of any post-COVID-19 condition when compared with the influenza group (17.9% vs. 13.0%), with a hazard ratio (HR) of 1.398 (95% CI, 1.251-1.562). Compared to the influenza group, the COVID-19 group had a significantly higher incidence of abnormal breathing (HR, 1.506; 95% CI, 1.246-1.822), abdominal symptoms (HR, 1.313; HR, 1.034-1.664), fatigue (HR, 1.486; 95% CI, 1.158-1.907), and cognitive symptoms (HR, 1.815; 95% CI, 1.235-2.668). Moreover, the COVID-19 group had a significantly higher risk of the composite outcomes during all-cause ED visits, hospitalizations, and deaths when compared with the influenza group (27.5% vs. 21.7; HR, 1.303; 95% CI, 1.194-1.422).

CONCLUSIONS

This study indicates that hospitalized COVID-19 patients are at a higher risk of long-term complications when compared with influenza survivors.