VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States of America.
Weill Cornell Medicine, New York, New York, United States of America.
PLoS One. 2024 Jun 6;19(6):e0298254. doi: 10.1371/journal.pone.0298254. eCollection 2024.
In randomized controlled trials, Nirmatrelvir/ritonavir (NMV/r) and Molnupiravir (MPV) reduced the risk of severe/fatal COVID-19 disease. Real-world data are limited, particularly studies directly comparing the two agents.
Using the VA National COVID-19 database, we identified previously uninfected, non-hospitalized individuals with COVID-19 with ≥1 risk factor for disease progression who were prescribed either NMV/r or MPV within 3 days of a positive test. We used inverse probability of treatment weights (IPTW) to account for providers' preferences for a specific treatment. Absolute risk difference (ARD) with 95% confidence intervals were determined for those treated with NMV/r vs. MPV. The primary outcome was hospitalization or death within 30 days of treatment prescription using the IPTW approach. Analyses were repeated using propensity-score matched groups.
Between January 1 and November 30, 2022, 9,180 individuals were eligible for inclusion (6,592 prescribed NMV/r; 2,454 prescribed MPV). The ARD for hospitalization/death for NMV/r vs MPV was -0.25 (95% CI -0.79 to 0.28). There was no statistically significant difference in ARD among strata by age, race, comorbidities, or symptoms at baseline. Kaplan-Meier curves did not demonstrate a difference between the two groups (p-value = 0.6). Analysis of the propensity-score matched cohort yielded similar results (ARD for NMV/r vs. MPV -0.9, 95% CI -2.02 to 0.23). Additional analyses showed no difference for development of severe/critical/fatal disease by treatment group.
We found no significant difference in short term risk of hospitalization or death among at-risk individuals with COVID-19 treated with either NMV/r or MPV.
在随机对照试验中，尼马曲韦/利托那韦（NMV/r）和莫努匹韦（MPV）降低了 COVID-19 重症/致死疾病的风险。真实世界的数据有限，特别是直接比较这两种药物的研究。
我们使用 VA 国家 COVID-19 数据库，确定了之前未感染、非住院的 COVID-19 患者，他们在阳性检测后 3 天内有≥1 种疾病进展的风险因素，并接受了 NMV/r 或 MPV 治疗。我们使用逆概率治疗权重（IPTW）来考虑提供者对特定治疗的偏好。使用 IPTW 方法，确定了接受 NMV/r 治疗与接受 MPV 治疗的患者之间的绝对风险差异（ARD）及其 95%置信区间。主要结局是治疗处方后 30 天内住院或死亡。使用倾向评分匹配组重复了分析。
2022 年 1 月 1 日至 11 月 30 日，共有 9180 人符合纳入标准（6592 人接受 NMV/r 治疗；2454 人接受 MPV 治疗）。NMV/r 与 MPV 相比，住院/死亡的 ARD 为-0.25（95%CI-0.79 至 0.28）。按年龄、种族、合并症或基线症状分层，ARD 无统计学差异。Kaplan-Meier 曲线显示两组之间无差异（p 值=0.6）。倾向评分匹配队列的分析结果相似（NMV/r 与 MPV 的 ARD-0.9，95%CI-2.02 至 0.23）。进一步分析显示，两组治疗后发生严重/危急/致死疾病的风险无差异。
我们发现，COVID-19 高危患者接受 NMV/r 或 MPV 治疗，短期住院或死亡风险无显著差异。
