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Measuring oral COVID-19 antiviral effectiveness using linked Australian data: Challenges and opportunities
Parveen Fathima1, Anish Scaria2, Sandrine Stepien2
1National Centre for Immunisation Research and Surveillance, New South Wales, Australia; Sydney School of Public Health, University of Sydney, New South Wales, Australia; Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Australia.
Oral antivirals significantly reduced severe COVID-19 outcomes in older adults. This study demonstrates the effectiveness of molnupiravir and nirmatrelvir-ritonavir using real-world health data, supporting their use in high-risk populations.
Area of Science:
- Public Health and Epidemiology
- Infectious Diseases
- Pharmacology
Background:
- Timely monitoring of COVID-19 antiviral effectiveness is crucial due to evolving SARS-CoV-2 variants, increasing vaccination, and hybrid immunity.
- High-risk populations require particular attention for effective COVID-19 management.
- Routinely collected health data offers a feasible approach for real-world effectiveness studies.
Purpose of the Study:
- To evaluate the feasibility of using routinely collected health data in Victoria, Australia.
- To estimate the real-world effectiveness of oral antivirals (molnupiravir and nirmatrelvir-ritonavir) against severe COVID-19 outcomes in older adults.
- To assess the impact of antiviral treatment on hospitalisation or death within 35 days of COVID-19 onset.
Main Methods:
- Analysis of record-linked, routinely collected health data for individuals aged ≥70 years with confirmed COVID-19 (July 2022 - March 2023).
- Application of three analytical methods: multivariable logistic regression, Cox regression, and target trial emulation.
- Assessment of associations between antiviral treatment and severe COVID-19 outcomes.
Main Results:
- Antiviral treatment was consistently associated with a reduced rate of severe outcomes across all analytical approaches.
- Estimated hazard ratios for reduced severe outcomes ranged from 0.62 (Cox model) to 0.45 (target trial emulation).
- An odds ratio of 0.28 (logistic model) further supported the protective effect of antiviral treatment.
Conclusions:
- Findings support the use of oral antivirals (molnupiravir and nirmatrelvir-ritonavir) in older adults for managing COVID-19.
- Triangulating multiple analytical approaches is valuable for interpreting observational data and understanding effectiveness variations.
- Improving the quality and standardization of routinely collected health data is essential for pandemic preparedness and evidence-based public health responses.
