Real-world clinical outcomes of treatment with molnupiravir for patients with mild-to-moderate coronavirus disease 2019 during the Omicron variant pandemic

Abstract

It is unclear whether molnupiravir has a beneficial effect on vaccinated patients infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We here evaluated the efficacy of molnupiravir in patients with mild-to-moderate coronavirus disease 2019 (COVID-19) during the Omicron variant surge in Fukushima Prefecture, Japan. We enrolled patients with mild-to-moderate COVID-19 who were admitted to hospitals between January and April, 2022. Clinical deterioration after admission was compared between molnupiravir users (n = 230) and non-users (n = 690) after 1:3 propensity score matching. Additionally, we performed forward stepwise multivariate logistic regression analysis to evaluate the association between clinical deterioration after admission and molnupiravir treatment in the 1:3 propensity score-matched subjects. The characteristics of participants in both groups were balanced as indicated by covariates with a standardized mean difference of < 0.1. Regarding comorbidities, there was no imbalance between the two groups, except for the presence of hypertension, dyslipidemia, diabetes mellitus, and cardiac disease. The clinical deterioration rate was significantly lower in the molnupiravir users compared to the non-users (3.90% vs 8.40%; P = 0.034). Multivariate logistic regression analysis demonstrated that receiving molnupiravir was a factor for preventing deterioration (odds ratio 0.448; 95% confidence interval 0.206–0.973; P = 0.042), independent of other covariates. This real-world study demonstrates that molnupiravir contributes to the prevention of deterioration in COVID-19 patients after hospitalization during the Omicron variant phase.

Drug treatment of COVID-19 infection

“…Three real-world studies performed in Hong Kong and Japan evaluated clinical effectiveness of nirmatrelvir-ritonavir and molnupiravir in people hospitalized with mild-to-moderate COVID-19 disease (Table 2 ). The large majority of included patients were more than 60 years old, and had adequate vaccination rates ranging from 10 to 80% [ 12 , 37 , 38 ]. Compared with matched controls, molnupiravir and nirmatrelvir-ritonavir were consistently associated with 40–55% lower risk of clinical deterioration.…”

“…Compared with matched controls, molnupiravir and nirmatrelvir-ritonavir were consistently associated with 40–55% lower risk of clinical deterioration. Moreover, molnupiravir was associated with 52–69%, and nirmatrelvir-ritonavir 66–90% lower risk of death respectively [ 12 , 37 , 38 ].…”

Molnupiravir: A Versatile Prodrug against SARS-CoV-2 Variants

“…The study stated that molnupiravir was safe and that it constitutes an alternative for such risk factors for COVID-19 [ 105 ]. Additionally, Suzuki et al reported a study utilizing 1929 micron-infected COVID-19 patients’ real-world data [ 106 ]. After 1:3 propensity score matching, clinical deterioration was compared between molnupiravir users (230 participants) and nonusers (690 participants).…”

The disease severity of COVID-19 caused by Omicron variants: A brief review

“…We identified 21 relevant papers and presented their recorded data in Table 1 . Eight studies from the T United States [6][7][8][9][10][11][12][13], five from South Africa [18][19][20][21][22], three from the United Kingdom [15][16][17], and three from other countries [14,[23][24][25][26] compared the severity of COVID-19 between the Omicron variants and previous variants. Two studies from Japan reported the proportion of severe COVID-19 cases without comparing different variants.…”