Molnupiravir is Effective for Reducing Death in High-Risk COVID-19 Patients

The antiviral agent, Molnupiravir, is likely to decrease the chances of hospitalization and death related to COVID-19.

In a randomized controlled trial, Molnupiravir (Lagevrio), was found to be effective as its alternative Nirmatrelvir-ritonavir (Paxlovid) (89%), as it decreased hospitalization and the likelihood of death by 30%.

Each oral agent were observed in the cohort study published in The Lancet Regional Health in early October, as real-world data is currently limited on the association between oral antiviral therapy and patients with mild-to-moderate COVID-19. The purpose of the study was to evaluate the clinical and cost effectiveness of each drug use in reducing mortality in patients with mild-to-moderate COVID-19. It was found that each agent not only decreased mortality, but also had significant cost savings.

In support of this study, data was collected on 54,355 high-risk patients in Hong Kong from February 22 to March 31, 2022. Real-world data was analyzed from the Hospital Authority, a publicly-funded health care system that covers 7.4 million population in Hong Kong.

According to the study, the first cluster of COVID-19 patients attributable to the Omicron variant in Hong Kong were identified January 6, 2022. As of April 30, approximately 1.2 million cases and 9,095 deaths were reported, although 82.6% and 43.1% of the population had been immunised with the 2nd and 3rd vaccine dose, respectively.

The trial engaged standard treatment for those analyzed with molnupiravir and nirmatrelvir-ritonavir for five days, followed by a second course if required.

The clinical outcomes of mild to moderately infected COVID patients over 60 years who were prescribed molnupiravir and nirmatrelvir-ritonavir were assessed. COVID-19 patients younger than 60 years of age but suffered from at least one chronic disease were also included.

In an outpatient portion of the study (61.1%), 16.1% used Molnupiravir and 13.4% used Nirmatrelvir-Ritonavir, while in the inpatient portion (38.9%), 3.8% used Molnupiravir and 1.3% used Nirmatrelvir-Ritonavir.

Nirmatrelvir-ritonavir was mostly given to younger patients or those with fewer comorbidities, while molnupiravir was recommended to older age groups with more comorbidities.

An inverse probability of treatment weighting-adjusted analysis (IPTW) revealed that mild to moderately infected COVID-19 patients who had high risk complications were associated with a 28-day survival rate.

As far as cost, ICERs for death averted for Molnupiravir stood at $493,345.09 (USD) in outpatient settings and $2,629.08 in inpatient settings. In outpatient settings, Nirmatrelvir-ritonavir cost $331,105.27 to avert one death, but saved $5,502.53 to avert one death in comparison with standard care.

According to the study, there were some limitations to support data such as symptom characteristics, COVID-19 vaccination status and vitals sign measurements.

Given that the patients in the trial were from Hong Kong, the adoption of these treatment regimens may only have limited applicability in different continents, where local cost-effectiveness evaluation, availability in market and healthcare financing models need to be further considered, the study encouraged.

However, it was suggested decision- and policy-makers should be informed of the potential benefits of each antiviral and recommend each as efficient treatments of COVID-19.