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Chang YC, Chen YC, Huang CC, Fu CM, Lee YT, Wu PJ, Lee WC, Lee CT, Liao SC, Tsai KF. Clinical effectiveness of molnupiravir in COVID-19 patients undergoing hemodialysis. Int J Antimicrob Agents 2023:106834. [PMID: 37127127 PMCID: PMC10148756 DOI: 10.1016/j.ijantimicag.2023.106834] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/07/2023] [Accepted: 04/27/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Molnupiravir is an essential oral antiviral agent against coronavirus disease 2019 (COVID-19); however, its real-world effectiveness has not been evaluated in patients undergoing hemodialysis (HD). METHODS We conducted a multicenter retrospective study involving 225 patients undergoing HD with initially mild or asymptomatic COVID-19 to compare the risks of 30-day COVID-19-related acute care visits between patients receiving and not receiving molnupiravir. Additionally, patients who received molnupiravir were stratified by rapid antigen detection (RAD) test results on day 7 after disease onset to assess whether rapid molnupiravir introduction accelerated viral clearance. RESULTS In our analysis, 30-day COVID-19-related acute care visits were reported in 9.41% and 21.74% of the molnupiravir and control groups, respectively, and use of molnupiravir markedly reduced the risk of acute care visits after adjusting for baseline characteristics via propensity score weighting (hazard ratio (95% confidence interval (CI)), 0.218 (0.074-0.642); p = 0.006). The tolerability of molnupiravir in the enrolled patients was generally acceptable, with only 11.88% of molnupiravir users reporting mild adverse events. Moreover, rapid initiation of molnupiravir within one day of COVID-19 onset was an independent predictor of conversion to a negative RAD test result on day 7 after disease onset (odds ratio (95% CI), 6.207 (2.509-15.358); p < 0.001). CONCLUSIONS Molnupiravir is well tolerated and decreases the medical needs in COVID-19 patients undergoing HD. Furthermore, the rapid initiation of molnupiravir accelerates viral clearance in HD patients with COVID-19. Our findings highlight the therapeutic role of molnupiravir for this vulnerable population.
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Affiliation(s)
- Yi-Chin Chang
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 123, Dabi Rd., Kaohsiung, 83301, Taiwan
| | - Yi-Chun Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 123, Dabi Rd., Kaohsiung, 83301, Taiwan
| | - Chiang-Chi Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 123, Dabi Rd., Kaohsiung, 83301, Taiwan
| | - Chung-Ming Fu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 123, Dabi Rd., Kaohsiung, 83301, Taiwan
| | - Yueh-Ting Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 123, Dabi Rd., Kaohsiung, 83301, Taiwan; Division of Nephrology, Department of Internal Medicine, Kaohsiung Municipal Feng-Shan Hospital, Kaohsiung, Taiwan; 42-1, Jingwu Rd., Kaohsiung, 83062, Taiwan
| | - Po-Jung Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 123, Dabi Rd., Kaohsiung, 83301, Taiwan
| | - Wen-Chin Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 123, Dabi Rd., Kaohsiung, 83301, Taiwan
| | - Chien-Te Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 123, Dabi Rd., Kaohsiung, 83301, Taiwan; Division of Nephrology, Department of Internal Medicine, Kaohsiung Municipal Feng-Shan Hospital, Kaohsiung, Taiwan; 42-1, Jingwu Rd., Kaohsiung, 83062, Taiwan
| | - Shang-Chih Liao
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 123, Dabi Rd., Kaohsiung, 83301, Taiwan; Division of Nephrology, Department of Internal Medicine, Kaohsiung Municipal Feng-Shan Hospital, Kaohsiung, Taiwan; 42-1, Jingwu Rd., Kaohsiung, 83062, Taiwan
| | - Kai-Fan Tsai
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 123, Dabi Rd., Kaohsiung, 83301, Taiwan.
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