Park Hye Rim, Yoo Min-Gyu, Kim Jong Mu, Bae Soon Jong, Lee Hyungmin, Kim Jungyeon
Patient Management Team, Central Disease Control Headquarters for COVID-19, Korea Disease Control and Prevention Agency, Cheongju, Korea.
Division of Public Health Emergency Response Research, Bureau of Public Health Emergency Preparedness, Korea Disease Control and Prevention Agency, Cheongju, Korea.
Infect Chemother. 2023 Dec;55(4):490-499. doi: 10.3947/ic.2023.0087. Epub 2023 Nov 22.
The MOVe-OUT (efficacy and safety of molnupiravir [MK-4482] in non-hospitalized adult participants with COVID-19 [MK-4482-002]) trial reported that the administration of molnupiravir in unvaccinated patients with coronavirus disease 2019 (COVID-19) before the Omicron epidemic showed a preventive effect of 31% against hospitalization and death. However, studies on the preventive effect of molnupiravir against progression to severe disease and death in patients with COVID-19 during the Omicron epidemic are limited. This study aimed to evaluate the preventive effect of molnupiravir against severe/critical illness or death and death in Korean patients with COVID-19 who were vaccinated mostly during the Omicron epidemic.
This study used large-scale retrospective cohort data to select patients with COVID-19 who were either treated or not treated with molnupiravir, between August 2022 and March 2023, at a ratio of 1 : 4 using the propensity score matching method. In total, 762,768 patients comprised the non- administered group, and 190,692 patients comprised the molnupiravir-administered group. The preventive effect of molnupiravir against severe/critical illness or death and death was analyzed using logistic regression analysis.
The preventive effect of molnupiravir against severe/critical illness or death and death, represented by the odds ratio (OR) and 95% confidence interval (CI), in the molnupiravir-administered and non-administered group was (OR: 0.714; CI: 0.667 - 0.764) and (OR: 0.749; CI: 0.682 - 0.823), respectively. As age increased, the preventive effect against severe/critical illness or death and death increased. The preventive effect against severe/critical illness or death at ≥60 years was (OR: 0.669; CI: 0.624 - 0.717), at ≥70 years was (OR: 0.614; CI: 0.570 - 0.661), and at ≥80 years was (OR: 0.563; CI: 0.515 - 0.615). The preventive effect against death at ≥60 years was (OR: 0.729; CI: 0.663 - 0.802), at ≥70 years was (OR: 0.676; CI: 0.612 - 0.747), and at ≥80 years was (OR: 0.622; CI: 0.554 - 0.698).
Although molnupiravir showed a relatively weak preventive effect against severe/critical illness or death (29%) and death (25%) among patients with COVID-19, it exhibited a stronger protective effect in older patients than in younger patients. In particular, the preventive effect against severe/critical illness or death (44%) and death (38%) in those aged ≥80 years was pronounced. This study strongly suggests that molnupiravir administration can alleviate the burden on the medical system, and treat patients with COVID-19 effectively by reducing its progression to severe disease and death.
“MOVe - OUT（莫努匹拉韦[MK - 4482]在未住院的2019冠状病毒病[COVID - 19]成年参与者中的疗效和安全性[MK - 4482 - 002]）”试验报告称，在奥密克戎毒株流行之前，对未接种疫苗的2019冠状病毒病（COVID - 19）患者使用莫努匹拉韦进行治疗，对住院和死亡的预防效果为31%。然而，关于莫努匹拉韦在奥密克戎毒株流行期间对COVID - 19患者进展为重症和死亡的预防作用的研究有限。本研究旨在评估莫努匹拉韦对主要在奥密克戎毒株流行期间接种疫苗的韩国COVID - 19患者发生重症/危重症或死亡以及死亡的预防作用。
本研究使用大规模回顾性队列数据，采用倾向评分匹配法，以1∶4的比例选取2022年8月至2023年3月期间接受或未接受莫努匹拉韦治疗的COVID - 19患者。未接受治疗组共有762,768例患者，接受莫努匹拉韦治疗组共有190,692例患者。使用逻辑回归分析评估莫努匹拉韦对重症/危重症或死亡以及死亡的预防作用。
莫努匹拉韦治疗组和未治疗组中，以比值比（OR）和95%置信区间（CI）表示的莫努匹拉韦对重症/危重症或死亡以及死亡的预防作用分别为（OR：0.714；CI：0.667 - 0.764）和（OR：0.749；CI：0.682 - 0.823）。随着年龄增加，对重症/危重症或死亡以及死亡的预防作用增强。60岁及以上患者对重症/危重症或死亡的预防作用为（OR：0.669；CI：0.624 - 0.717），70岁及以上为（OR：0.614；CI：0.570 - 0.661），80岁及以上为（OR：0.563；CI：0.515 - 0.615）。60岁及以上患者对死亡的预防作用为（OR：0.729；CI：0.663 - 0.802），70岁及以上为（OR：0.676；CI：0.612 - 0.747），80岁及以上为（OR：0.622；CI：0.554 - 0.698）。
尽管莫努匹拉韦对COVID - 19患者的重症/危重症或死亡（29%）以及死亡（25%）的预防作用相对较弱，但在老年患者中比在年轻患者中表现出更强的保护作用。特别是，对80岁及以上患者的重症/危重症或死亡（44%）以及死亡（38%）的预防作用显著。本研究有力地表明，使用莫努匹拉韦可以减轻医疗系统的负担，并通过减少进展为重症和死亡来有效治疗COVID - 19患者。
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