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

TitleEffectiveness of Molnupiravir and Nirmatrelvir-Ritonavir in CKD Patients With COVID-19
Authors
Keywordsantivirals
CKD
COVID-19
EHR
emulated trial
Issue Date1-May-2024
PublisherElsevier
Citation
Kidney International Reports, 2024, v. 9, n. 5, p. 1244-1253 How to Cite?
AbstractIntroduction: 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.
Persistent Identifierhttp://hdl.handle.net/10722/344639

 

DC FieldValueLanguage
dc.contributor.authorCheng, Franco Wing Tak-
dc.contributor.authorYan, Vincent Ka Chun-
dc.contributor.authorWan, Eric Yuk Fai-
dc.contributor.authorChui, Celine Sze Ling-
dc.contributor.authorLai, Francisco Tsz Tsun-
dc.contributor.authorWong, Carlos King Ho-
dc.contributor.authorLi, Xue-
dc.contributor.authorZhang, Irene Ran-
dc.contributor.authorTang, Sydney Chi Wai-
dc.contributor.authorWong, Ian Chi Kei-
dc.contributor.authorChan, Esther Wai Yin-
dc.date.accessioned2024-07-31T06:22:43Z-
dc.date.available2024-07-31T06:22:43Z-
dc.date.issued2024-05-01-
dc.identifier.citationKidney International Reports, 2024, v. 9, n. 5, p. 1244-1253-
dc.identifier.urihttp://hdl.handle.net/10722/344639-
dc.description.abstractIntroduction: 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.-
dc.languageeng-
dc.publisherElsevier-
dc.relation.ispartofKidney International Reports-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectantivirals-
dc.subjectCKD-
dc.subjectCOVID-19-
dc.subjectEHR-
dc.subjectemulated trial-
dc.titleEffectiveness of Molnupiravir and Nirmatrelvir-Ritonavir in CKD Patients With COVID-19-
dc.typeArticle-
dc.identifier.doi10.1016/j.ekir.2024.02.009-
dc.identifier.scopuseid_2-s2.0-85186574186-
dc.identifier.volume9-
dc.identifier.issue5-
dc.identifier.spage1244-
dc.identifier.epage1253-
dc.identifier.eissn2468-0249-
dc.identifier.issnl2468-0249-

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