Effectiveness of Molnupiravir and Nirmatrelvir-Ritonavir in CKD Patients With COVID-19
Introduction: Even with effective vaccines, patients with CKD have a higher risk of hospitalization and death subsequent to COVID-19 infection than those without CKD. Molnupiravir and nirmatrelvir-ritonavir have been approved for emergency use, but their effectiveness for the CKD population is still...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-05-01
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| Series: | Kidney International Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024924000986 |
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| author | Franco Wing Tak Cheng Vincent Ka Chun Yan Eric Yuk Fai Wan Celine Sze Ling Chui Francisco Tsz Tsun Lai Carlos King Ho Wong Xue Li Irene Ran Zhang Sydney Chi Wai Tang Ian Chi Kei Wong Esther Wai Yin Chan |
| author_facet | Franco Wing Tak Cheng Vincent Ka Chun Yan Eric Yuk Fai Wan Celine Sze Ling Chui Francisco Tsz Tsun Lai Carlos King Ho Wong Xue Li Irene Ran Zhang Sydney Chi Wai Tang Ian Chi Kei Wong Esther Wai Yin Chan |
| author_sort | Franco Wing Tak Cheng |
| collection | DOAJ |
| description | Introduction: Even with effective vaccines, patients with CKD have a higher risk of hospitalization and death subsequent to COVID-19 infection than those without CKD. Molnupiravir and nirmatrelvir-ritonavir have been approved for emergency use, but their effectiveness for the CKD population is still unknown. This study was conducted to determine the effectiveness of these drugs in reducing mortality and severe COVID-19 in the CKD population. Methods: This was a target trial emulation study using electronic health databases in Hong Kong. Patients with CKD aged 18 years or older who were hospitalized with COVID-19 were included. The per-protocol average treatment effect among COVID-19 oral antiviral initiators, including all-cause mortality, intensive care unit (ICU) admission, and ventilatory support within 28 days, were compared to noninitiators. Results: Antivirals have been found to lower the risk of all-cause mortality, with Molnupiravir at a hazard ratio (HR) of 0.85 (95% confidence interval [CI], 0.77 to 0.95] and nirmatrelvir-ritonavir at an HR of 0.78 [95% CI, 0.60 to 1.00]. However, they do not significantly reduce the risk of ICU admission (molnupiravir: HR, 0.88 [95% CI, 0.59 to 1.30]; nirmatrelvir-ritonavir: HR, 0.86 [95% CI, 0.56 to 1.32]) or ventilatory support (molnupiravir: HR, 1.00 [95% CI, 0.76 to 1.33]; nirmatrelvir-ritonavir: HR, 1.01 [95% CI, 0.74 to 1.37]). There was a greater risk reduction in males and those with higher Charlson Comorbidity Index (CCI). The nirmatrelvir-ritonavir trial also showed reduced risk for those who had antiviral treatment and received 3 or more vaccine doses. Conclusion: Both molnupiravir and nirmatrelvir-ritonavir reduced mortality rates for hospitalized COVID-19 patients with CKD. |
| format | Article |
| id | doaj-art-1396ee1f7f5b40e29e8b064a791d21c5 |
| institution | Kabale University |
| issn | 2468-0249 |
| language | English |
| publishDate | 2024-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj-art-1396ee1f7f5b40e29e8b064a791d21c52025-08-20T03:45:07ZengElsevierKidney International Reports2468-02492024-05-01951244125310.1016/j.ekir.2024.02.009Effectiveness of Molnupiravir and Nirmatrelvir-Ritonavir in CKD Patients With COVID-19Franco Wing Tak Cheng0Vincent Ka Chun Yan1Eric Yuk Fai Wan2Celine Sze Ling Chui3Francisco Tsz Tsun Lai4Carlos King Ho Wong5Xue Li6Irene Ran Zhang7Sydney Chi Wai Tang8Ian Chi Kei Wong9Esther Wai Yin Chan10Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, ChinaCentre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, ChinaCentre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong Special Administrative Region, China; Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, ChinaLaboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong Special Administrative Region, China; School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, ChinaCentre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong Special Administrative Region, ChinaCentre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong Special Administrative Region, China; Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, ChinaCentre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong Special Administrative Region, China; Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, ChinaDepartment of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, ChinaDepartment of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, ChinaCentre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong Special Administrative Region, China; Aston Pharmacy School, Aston University, Birmingham, UK; Ian Chi Kei Wong, L2-57, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong.Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong Special Administrative Region, China; Correspondence: Esther Wai Yin Chan, Department of Pharmacology and Pharmacy, Room 105G, 1/F, The Jockey Club Building for Interdisciplinary Research (JCBIR), 5 Sassoon Road, Pokfulam, Hong Kong.Introduction: Even with effective vaccines, patients with CKD have a higher risk of hospitalization and death subsequent to COVID-19 infection than those without CKD. Molnupiravir and nirmatrelvir-ritonavir have been approved for emergency use, but their effectiveness for the CKD population is still unknown. This study was conducted to determine the effectiveness of these drugs in reducing mortality and severe COVID-19 in the CKD population. Methods: This was a target trial emulation study using electronic health databases in Hong Kong. Patients with CKD aged 18 years or older who were hospitalized with COVID-19 were included. The per-protocol average treatment effect among COVID-19 oral antiviral initiators, including all-cause mortality, intensive care unit (ICU) admission, and ventilatory support within 28 days, were compared to noninitiators. Results: Antivirals have been found to lower the risk of all-cause mortality, with Molnupiravir at a hazard ratio (HR) of 0.85 (95% confidence interval [CI], 0.77 to 0.95] and nirmatrelvir-ritonavir at an HR of 0.78 [95% CI, 0.60 to 1.00]. However, they do not significantly reduce the risk of ICU admission (molnupiravir: HR, 0.88 [95% CI, 0.59 to 1.30]; nirmatrelvir-ritonavir: HR, 0.86 [95% CI, 0.56 to 1.32]) or ventilatory support (molnupiravir: HR, 1.00 [95% CI, 0.76 to 1.33]; nirmatrelvir-ritonavir: HR, 1.01 [95% CI, 0.74 to 1.37]). There was a greater risk reduction in males and those with higher Charlson Comorbidity Index (CCI). The nirmatrelvir-ritonavir trial also showed reduced risk for those who had antiviral treatment and received 3 or more vaccine doses. Conclusion: Both molnupiravir and nirmatrelvir-ritonavir reduced mortality rates for hospitalized COVID-19 patients with CKD.http://www.sciencedirect.com/science/article/pii/S2468024924000986antiviralsCKDCOVID-19EHRemulated trial |
| spellingShingle | Franco Wing Tak Cheng Vincent Ka Chun Yan Eric Yuk Fai Wan Celine Sze Ling Chui Francisco Tsz Tsun Lai Carlos King Ho Wong Xue Li Irene Ran Zhang Sydney Chi Wai Tang Ian Chi Kei Wong Esther Wai Yin Chan Effectiveness of Molnupiravir and Nirmatrelvir-Ritonavir in CKD Patients With COVID-19 Kidney International Reports antivirals CKD COVID-19 EHR emulated trial |
| title | Effectiveness of Molnupiravir and Nirmatrelvir-Ritonavir in CKD Patients With COVID-19 |
| title_full | Effectiveness of Molnupiravir and Nirmatrelvir-Ritonavir in CKD Patients With COVID-19 |
| title_fullStr | Effectiveness of Molnupiravir and Nirmatrelvir-Ritonavir in CKD Patients With COVID-19 |
| title_full_unstemmed | Effectiveness of Molnupiravir and Nirmatrelvir-Ritonavir in CKD Patients With COVID-19 |
| title_short | Effectiveness of Molnupiravir and Nirmatrelvir-Ritonavir in CKD Patients With COVID-19 |
| title_sort | effectiveness of molnupiravir and nirmatrelvir ritonavir in ckd patients with covid 19 |
| topic | antivirals CKD COVID-19 EHR emulated trial |
| url | http://www.sciencedirect.com/science/article/pii/S2468024924000986 |
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