Effectiveness, Tolerability and Prescribing Choice of Antiviral Molecules Molnupiravir, Remdesivir and Nirmatrelvir/r: A Real-World Comparison in the First Ten Months of Use

Abstract

In 2022, three antiviral drugs—molnupiravir, remdesivir and nirmatrelvir/ritonavir—were introduced for treatment of mild-to-moderate COVID-19 in high-risk patients. The aim of this study is the evaluation of their effectiveness and tolerability in a real-life setting. A single-center observational study was set up, with the involvement of 1118 patients, with complete follow-up data, treated between the 5th of January and the 3rd of October 2022 at Santa Maria Goretti’s hospital in Latina, Central Italy. A univariable and a multivariable analysis were performed on clinical and demographic data and composite outcome, the persistence of symptoms at 30 days and time to negativization, respectively. The three antivirals showed a similar effectiveness in containing the progression of the infection to severe COVID-19 and a good tolerability in the absence of serious adverse effects. Persistence of symptoms after 30 days was more common in females than males and less common in patients treated with molnupiravir and nirmatrelvir/r. The availability of different antiviral molecules is a strong tool and, if correctly prescribed, they can have a significant role in changing the natural history of infection for frail persons, in which vaccination could be not sufficient for the prevention of severe COVID-19.

Vaccination and Antiviral Treatment Reduce the Time to Negative SARS-CoV-2 Swab: A Real-Life Study

“…The impact of vaccination on TLN was also highlighted by Li et al In their study, the authors showed that TLN was increased according to aging, female gender, fever, cough, and disease severity while consistently shortened according to vaccine doses [24]. Similar findings were reported by Del Borgo et al in a prospective study conducted in Italy, confirming the efficacy of vaccinations in reducing TLN [25].…”

“…A shorter median time was described for nirmatrelvir/ritonavir when compared to remdesivir and molnupiravir (8 vs. 10 days). In this study, 230 people received remdesivir three-day course, 499 molnupiravir, and 398 nirmatrelvir/ritonavir [25]. The efficacy of nirmatrelvir/ritonavir was reported in a prospective study where it was compared with sotrovimab.…”

Special Issue “Efficacy and Safety of Antiviral Therapy”

“…Regarding the prevention of COVID-19, we have learned more about the efficacy of early antiviral therapies. The studies presented by Del Borgo et al and De Vito et al [ 2 , 3 ] evaluated the efficacy of antiviral therapies, confirming the results from the available literature [ 4 , 5 ]. Rombini et al, on the contrary, evaluated the efficacy of a Nucleoside Reverse Transcriptase Inhibitor (NRTI) already approved for the treatment of HIV.…”

In Vitro Combinatorial Activity of Direct Acting Antivirals and Monoclonal Antibodies against the Ancestral B.1 and BQ.1.1 SARS-CoV-2 Viral Variants

“…On the other hand, DAA has maintained their activity across multiple variants due to the high conservation of the targeted viral enzymes [ 7 ]. However, current DAA may be unable to fully prevent severe disease progression, and their use is limited by a number of drug–drug interactions (NRM), inconvenient administration (RDV), or mutagenicity concerns (MNP) [ 8 ]. Indeed, the development of novel drugs or different therapeutic approaches remains a key priority [ 9 ].…”