Effectiveness of Molnupiravir and Nirmatrelvir-Ritonavir in CKD Patients With COVID-19

Abstract

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.

Publication DOI: https://doi.org/10.1016/j.ekir.2024.02.009
Divisions: College of Health & Life Sciences > Aston Pharmacy School
Funding Information: This work was supported by a research grant from the Food and Health Bureau; HMRF Research on COVID-19, The Government of the Hong Kong Special Administrative Region (Principal Investigator (WP2): EWC; Ref: COVID1903011). ICKW and FTTL are partially suppo
Additional Information: (c) 2024 International Society of Nephrology. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Uncontrolled Keywords: CKD,emulated trial,antivirals,COVID-19,EHR
Publication ISSN: 2468-0249
Last Modified: 20 Dec 2024 08:27
Date Deposited: 20 May 2024 09:47
Full Text Link:
Related URLs: https://linking ... 468024924000986 (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2024-05
Published Online Date: 2024-02-09
Accepted Date: 2024-02-05
Submitted Date: 2023-08-06
Authors: Cheng, Franco Wing Tak
Yan, Vincent Ka Chun
Wan, Eric Yuk Fai
Chui, Celine Sze Ling
Lai, Francisco Tsz Tsun
Wong, Carlos King Ho
Li, Xue
Zhang, Irene Ran
Tang, Sydney Chi Wai
Wong, Ian Chi Kei (ORCID Profile 0000-0001-8242-0014)
Chan, Esther Wai Yin

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