3 days ago
Oral Antivirals Show No Benefit in Hospital COVID-19 Care
TOPLINE:
In patients hospitalized with COVID-19, adding molnupiravir or nirmatrelvir-ritonavir to usual care was not associated with improved clinical outcomes, including 28-day mortality duration of hospital stay or progression to invasive ventilation or death.
METHODOLOGY:
Researchers conducted a randomized, controlled trial to evaluate the efficacy of oral antivirals molnupiravir and nirmatrelvir-ritonavir on clinical outcomes in patients with COVID-19 during the Omicron period.
Overall, 445 patients hospitalized with confirmed SARS-CoV-2 infection received molnupiravir (mean age, 71.4 years; 83% received the COVID-19 vaccine ) and 68 received nirmatrelvir-ritonavir (mean age, 72.5 years; 85% received the COVID-19 vaccine ) in addition to usual care. Each group was matched with an approximately equal number of patients who received usual care alone.
The primary outcome was 28-day all-cause mortality, and secondary outcomes included progression to invasive mechanical ventilation or death.
TAKEAWAY:
No significant differences were observed between the molnupiravir and usual care groups in 28-day mortality (hazard ratio [HR], 0.93; P = .66) or time to discharge alive within 28 days (HR, 0.96; P = .60).
Similarly, outcomes for nirmatrelvir-ritonavir were comparable to usual care, with no significant differences in 28-day mortality (HR, 1.02) or time to discharge alive within 28 days (HR, 0.80).
The duration of hospitalization or the proportion of participants progressing to invasive ventilation or death was not significantly different in either of the comparisons (risk ratio, 0.96; P = .75).
IN PRACTICE:
'Interpreting the results of this study, it is unlikely that adding molnupiravir to usual care has significant clinical benefit in this group of patients. On the other hand, it is difficult to conclude whether nirmatrelvir-ritonavir improves clinical outcomes in hospitalized patients due to the restricted sample size,' the authors of a linked commentary wrote.
SOURCE:
This study was led by Peter W. Horby, Nuffield Department of Medicine, University of Oxford, Oxford, England. It was published online on May 15, 2025, in The Lancet Infectious Diseases.
LIMITATIONS:
Both comparisons were discontinued due to low recruitment.
DISCLOSURES:
This study was funded by UK Research and Innovation, the National Institute for Health and Care Research, and the Wellcome Trust. Two authors reported having financial relationships with pharmaceutical companies such as Pfizer and MSD.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
