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. 2023 Oct 2;23(1):646.
doi: 10.1186/s12879-023-08538-9.

Comparison between available early antiviral treatments in outpatients with SARS-CoV-2 infection: a real-life study

Matteo Rinaldi  1   2 , Caterina Campoli  3   4 , Mena Gallo  3 , Domenico Marzolla  3   4 , Alberto Zuppiroli  3   4 , Riccardo Riccardi  3   4 , Martina Casarini  3   4 , Daniele Riccucci  3   4 , Marta Malosso  3   4 , Cecilia Bonazzetti  3   4 , Renato Pascale  3   4 , Beatrice Tazza  3   4 , Zeno Pasquini  3   4 , Lorenzo Marconi  3   4 , Stefania Curti  3 , Maddalena Giannella  3   4 , Pierluigi Viale  3   4
Affiliations

Comparison between available early antiviral treatments in outpatients with SARS-CoV-2 infection: a real-life study

Matteo Rinaldi et al. BMC Infect Dis. .

Abstract

Purpose: To investigate the clinical impact of three available antivirals for early COVID-19 treatment in a large real-life cohort.

Methods: Between January and October 2022 all outpatients tested positive for SARS-CoV-2 referring to IRCCS S. Orsola hospital treated with an early antiviral therapy were enrolled. A comparison between patients treated with nirmatrelvir/ritonavir (NTV/r), molnupiravir (MPV) and remdesivir (RDV) was conducted in term of indications and outcome. To account for differences between treatment groups a propensity score analysis was performed. After estimating the weights, we fitted a survey-weighted Cox regression model with inverse-probability weighting with hospital admission/death versus clinical recovery as the primary outcome.

Results: Overall 1342 patients were enrolled, 775 (57.8%), 360 (26.8%) and 207 (15.4%) in MPV, NTV/r and RDV group, respectively. Median age was 73 (59-82) years, male sex was 53.4%. Primary indication was immunosuppression (438, 32.6%), the median time from symptom onset to drug administration was 3 [2-4] days. Overall, clinical recovery was reached in 96.9% of patients, with hospital admission rate of 2.6%. No significant differences were found in clinical recovery nor hospitalization. Cox regression showed a decreased probability of hospital admission/ death among prior vaccinated patients compared with unvaccinated (HR 0.31 [95%CI 0.14-0.70], p = 0.005]). No difference in hospitalization rates in early treatment compared to late treatment were found.

Conclusions: No differences among MPV, NTV/r and RDV in terms of clinical recovery or hospitalization were found. Patients not vaccinated had a significant increased risk of hospitalization.

Keywords: Early antiviral treatment, real-life cohort; SARS-CoV-2.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Boxplot by treatment group of the estimated propensity scores. a. Molnupiravir propensity scores by treatment group b. Nirmatrelvir propensity scores by treatment group c. Remdesivir propensity scores by treatment group
Fig. 2
Fig. 2
Plot of time-varying HR of hospital admission or death for time from symptoms onset to treatment as per survey-weighted Cox model. Reference category: 0–1 days. Curves were estimated using the formula reported in the notes of Table 3
See this image and copyright information in PMC

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