1. Efficacy of COVID-19 Oral antivirals in hospitalised oldest-old with high morbidity burden: a target trial emulation study.
- Author
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Lai FTT, Wang B, Wei C, Chui CSL, Li X, Cheung CL, Wong ICK, Chan EWY, and Wan EYF
- Subjects
- Humans, Male, Female, Aged, 80 and over, Hong Kong epidemiology, Administration, Oral, Ritonavir therapeutic use, Ritonavir administration & dosage, COVID-19 mortality, COVID-19 epidemiology, Hydroxylamines administration & dosage, Hydroxylamines therapeutic use, Treatment Outcome, Cytidine analogs & derivatives, Cytidine administration & dosage, Cytidine therapeutic use, Leucine analogs & derivatives, Antiviral Agents administration & dosage, Antiviral Agents therapeutic use, COVID-19 Drug Treatment, Hospitalization statistics & numerical data, SARS-CoV-2
- Abstract
Background: Molnupiravir and nirmatrelvir-ritonavir are orally administered pharmacotherapies for mild to moderate COVID-19. However, the effectiveness of these drugs among very old (≥80 years), hospitalised patients remains unclear, limiting the risk-benefit assessment of these antivirals in this specific group. This study investigates the effectiveness of these antivirals in reducing mortality among this group of hospitalised patients with COVID-19., Methods: Using a territory-wide public healthcare database in Hong Kong, a target trial emulation study was conducted with data from 13 642 eligible participants for the molnupiravir trial and 9553 for the nirmatrelvir-ritonavir trial. The primary outcome was all-cause mortality. Immortal time and confounding bias was minimised using cloning-censoring-weighting approach. Mortality odds ratios were estimated by pooled logistic regression after adjusting confounding biases by stabilised inverse probability weights., Results: Both molnupiravir (HR: 0.895, 95% CI: 0.826-0.970) and nirmatrelvir-ritonavir (HR: 0.804, 95% CI: 0.678-0.955) demonstrated moderate mortality risk reduction among oldest-old hospitalised patients. No significant interaction was observed between oral antiviral treatment and vaccination status. The 28-day risk of mortality was lower in initiators than non-initiators for both molnupiravir (risk difference: -1.09%, 95% CI: -2.29, 0.11) and nirmatrelvir-ritonavir (risk difference: -1.71%, 95% CI: -3.30, -0.16) trials. The effectiveness of these medications was observed regardless of the patients' prior vaccination status., Conclusions: Molnupiravir and nirmatrelvir-ritonavir are moderately effective in reducing mortality risk among hospitalised oldest-old patients with COVID-19, regardless of their vaccination status., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2024
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