Real-world experience with molnupiravir during the period of SARS-CoV-2 Omicron variant dominance

Abstract

Background. The real-world effectiveness of molnupiravir (MOL) during the dominance of Omicron SARS-CoV-2 lineage is urgently needed since the available data relates to the period of circulation of other viral variants. Therefore, this study assessed the efficacy of MOL in patients hospitalized for COVID-19 in a real-world clinical practice during the wave of Omicron infections. Methods. Among 11822 patients hospitalized after 1 March 2020 and included in the SARSTer national database, 590 were treated between 1 January and 31 April 2022, a period of dominance of the Omicron SARS-CoV-2 variant. MOL was administered to 203 patients, whereas 387 did not receive any antiviral regimen. Both groups were similar in terms of sex, BMI and age allowing for direct comparisons Results. Patients who did not receive antiviral therapy significantly more often required the use of Dexamethasone and Baricitinib. Treatment with MOL resulted in a statistically significant reduction in mortality during the 28-day follow-up (9.9 vs. 16.3%), which was particularly evident in the population of patients over 80 years of age treated in the first 5 days of the disease (14.6 vs. 35.2%). MOL therapy did not affect the frequency of the need for mechanical ventilation, but patients treated with MOL required oxygen supplementation less frequently than those without antivirals (31.7 vs. 49.2%). The time of hospitalization did not differ between groups. Conclusions. The use of molnupiravir in patients hospitalized for COVID-19 during the dominance of Omicron variant reduced mortality. This effect is particularly evident in patients over 80 years of age.

Clinical evidence of the effectiveness of remdesivir in COVID-19 during periods dominated by Delta and Omicron SARS-CoV-2 variants.

“…]90, and acute respiratory distress syndrome (ARDS). The clinical course of the disease was assessed on admission to the hospital, and then after 7, 14, 21, and 28 days using an ordinal scale based on WHO recommendations, it was modified to the 8-point version to match the specificity of the Polish healthcare system and used in previous SARSTer research 24,25 . The score was defined as follows: (1) not hospitalized, no activity restrictions; (2) not hospitalized, no activity restrictions and/or not requiring oxygen supplementation at home; (3) hospitalized, and not requiring oxygen supplementation and not requiring medical care; (4) hospitalized, not requiring oxygen supplementation, but requiring medical care; (5) hospitalized, requiring normal oxygen supplementation; (6) hospitalized, requiring non-invasive ventilation with high-flow oxygen equipment; (7) hospitalized, for invasive mechanical ventilation or extracorporeal membrane oxygenation; (8) death.…”

Antiviral drugs against SARS-CoV-2

“…In addition, recent real-world data originating from a large cohort during Omicron BA.2 dominance confirms that molnupiravir reduces the risk of progression and mechanical ventilation [ 17 ]. Another recent real-world study conducted in Poland during the dominance of the Omicron variant evidenced that administration of molnupiravir in hospitalized patients within five days from symptoms onset resulted in reduced mortality and less frequent use of oxygen supplementation [ 18 ].…”