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Effectiveness of Molnupiravir and Nirmatrelvir-Ritonavir in CKD Patients With COVID-19
Franco Wing Tak Cheng1, Vincent Ka Chun Yan1, Eric Yuk Fai Wan1,2,3
1Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Insights
Oral antivirals like molnupiravir and nirmatrelvir-ritonavir effectively reduced mortality in hospitalized COVID-19 patients with chronic kidney disease (CKD). These findings offer crucial insights for managing high-risk populations during the pandemic.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Patients with chronic kidney disease (CKD) face elevated risks of severe outcomes and mortality following COVID-19 infection, even with vaccination.
- The efficacy of emergency-approved oral antivirals, molnupiravir and nirmatrelvir-ritonavir, remains uncertain for the CKD population.
Purpose of the Study:
- To evaluate the effectiveness of molnupiravir and nirmatrelvir-ritonavir in reducing mortality and severe COVID-19 among hospitalized patients with CKD.
Main Methods:
- A target trial emulation study utilized electronic health databases in Hong Kong.
- Included were hospitalized COVID-19 patients aged 18+ with CKD.
- Compared were outcomes (all-cause mortality, ICU admission, ventilatory support within 28 days) between oral antiviral initiators and non-initiators.
Main Results:
- Both molnupiravir (HR 0.85; 95% CI, 0.77-0.95) and nirmatrelvir-ritonavir (HR 0.78; 95% CI, 0.60-1.00) significantly reduced all-cause mortality.
- Neither antiviral significantly decreased the risk of ICU admission or need for ventilatory support.
- Greater mortality risk reduction was observed in males, those with higher Charlson Comorbidity Index scores, and patients receiving nirmatrelvir-ritonavir with 3+ vaccine doses.
Conclusions:
- Molnupiravir and nirmatrelvir-ritonavir demonstrate effectiveness in lowering mortality rates for hospitalized COVID-19 patients with CKD.
- These oral antivirals represent valuable therapeutic options for mitigating severe outcomes in this vulnerable patient group.
Introduction:
Even with effective vaccines, patients with CKD have a higher risk of hospitalization and death subsequent to COVID-19 infection than those without CKD. Molnupiravir and nirmatrelvir-ritonavir have been approved for emergency use, but their effectiveness for the CKD population is still unknown. This study was conducted to determine the effectiveness of these drugs in reducing mortality and severe COVID-19 in the CKD population.
Methods:
This was a target trial emulation study using electronic health databases in Hong Kong. Patients with CKD aged 18 years or older who were hospitalized with COVID-19 were included. The per-protocol average treatment effect among COVID-19 oral antiviral initiators, including all-cause mortality, intensive care unit (ICU) admission, and ventilatory support within 28 days, were compared to noninitiators.
Results:
Antivirals have been found to lower the risk of all-cause mortality, with Molnupiravir at a hazard ratio (HR) of 0.85 (95% confidence interval [CI], 0.77 to 0.95] and nirmatrelvir-ritonavir at an HR of 0.78 [95% CI, 0.60 to 1.00]. However, they do not significantly reduce the risk of ICU admission (molnupiravir: HR, 0.88 [95% CI, 0.59 to 1.30]; nirmatrelvir-ritonavir: HR, 0.86 [95% CI, 0.56 to 1.32]) or ventilatory support (molnupiravir: HR, 1.00 [95% CI, 0.76 to 1.33]; nirmatrelvir-ritonavir: HR, 1.01 [95% CI, 0.74 to 1.37]). There was a greater risk reduction in males and those with higher Charlson Comorbidity Index (CCI). The nirmatrelvir-ritonavir trial also showed reduced risk for those who had antiviral treatment and received 3 or more vaccine doses.
Conclusion:
Both molnupiravir and nirmatrelvir-ritonavir reduced mortality rates for hospitalized COVID-19 patients with CKD.
