In a study from The University of Hong Kong, scientists conducted one of the first real-world studies to explore the inpatient use of oral antivirals during a pandemic wave dominated by the SARS-CoV-2 omicron variant.
The use of oral antivirals in patients with COVID-19 may lower their risks of hospitalization and death and reduce the burden on healthcare systems.
Clinical trials observed no clinical benefits with molnupiravir use in the inpatient setting among patients with moderate-to-severe COVID-19, and reported reductions in the hospitalization or death with oral antivirals use (30% for molnupiravir and 88% for nirmatrelvir–ritonavir respectively) in non-hospitalized patients with mild-to-moderate COVID-19.
However, real-world evidence of oral antiviral use in patients infected with the SARS-CoV-2 omicron variant is insufficient.
In the study, the team analyzed data from a territory-wide retrospective cohort of patients in Hong Kong who were hospitalized with a confirmed diagnosis of SARS-CoV-2 infection between 26 February and 26 April 2022.
Among 40,776 patients hospitalized with SARS-CoV-2 infection during the study period, we selected patients who were eligible to receive oral antivirals.
This analysis included 1,856 early molnupiravir recipients (i.e. receiving molnupiravir within the first two days of admission) and 1,856 matched controls, and 890 early nirmatrelvir-ritonavir recipients and 890 matched controls.
Lower risk of all-cause mortality was observed in molnupiravir recipients versus matched controls and in nirmatrelvir–ritonavir recipients versus matched controls.
Oral antiviral recipients also had lower risks of the composite disease progression outcome and need for oxygen therapy than controls.
Time to achieving a low viral burden was significantly shorter among oral antiviral recipients than matched controls.
The team says current guidelines are now prioritizing the distribution of oral antivirals to those who do not require supplemental oxygen but are at the highest risk of disease progression.
This study cohort reflected such a prescription pattern in real-world clinical practice, consisting of mostly older people with multiple pre-existing comorbidities and who had not been fully vaccinated
The antiviral effect and mortality benefit observed in this patient cohort support the use of oral antivirals in patients with COVID-19 who do not require supplemental oxygen on admission during a pandemic wave of the omicron variant.
These findings support the use of these antivirals in this population.
As both oral antivirals are currently indicated for non-hospitalized patients with COVID-19 who are at high risk of disease progression, ongoing research will inform the safety and effectiveness of oral antivirals in specific patient populations, drug combinations, and healthcare settings.
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The study was conducted by Dr. Carlos Wong King-ho et al and published in The Lancet Infectious Diseases.
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