Effectiveness of COVID-19 treatment with nirmatrelvir-ritonavir or molnupiravir among U.S. Veterans: target trial emulation studies with one-month and six-month outcomes
et al., medRxiv,
Effectiveness of COVID-19 treatment with nirmatrelvir-ritonavir or molnupiravir among U.S. Veterans: target..
, medRxiv, doi:10.1101/2022.12.05.22283134 (Preprint)
Retrospective 112,380 high-risk patients in the USA, showing significantly higher acute or long-term care admission at 180 days with molnupiravir treatment, and no significant difference for other outcomes. The title and headers of Table S14 are conflicting but the data appears to match be title.Concerns have been raised that the mutagenic mechanism of action may create dangerous variants or cause cancer [Hadj Hassine, Swanstrom]. See  for analysis of a variant potentially created by molnupiravir.
risk of death, 18.0% lower, HR 0.82, p = 0.40, treatment 24 of 897 (2.7%), control 29.0 of 897 (3.2%), NNT 179, cumulative 0-180 days, propensity score matching, day 180, Table S14.
risk of death, 49.3% lower, RR 0.51, p = 0.19, treatment 7 of 897 (0.8%), control 13.8 of 897 (1.5%), NNT 132, propensity score matching, day 30.
risk of mechanical ventilation, 16.7% lower, RR 0.83, p = 1.00, treatment 3 of 897 (0.3%), control 3.6 of 897 (0.4%), NNT 1495, propensity score matching, day 30.
risk of ICU admission, 1.0% lower, RR 0.99, p = 1.00, treatment 10 of 897 (1.1%), control 10.1 of 897 (1.1%), NNT 8970, propensity score matching, day 30.
risk of hospitalization, 30.0% higher, HR 1.30, p = 0.04, treatment 162 of 897 (18.1%), control 124.3 of 897 (13.9%), cumulative 0-180 days, propensity score matching, day 180, Table S14.
risk of hospitalization, 8.6% lower, RR 0.91, p = 0.73, treatment 37 of 897 (4.1%), control 40.5 of 897 (4.5%), NNT 256, propensity score matching, day 30.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Bajema et al., 6 Dec 2022, retrospective, USA, preprint, median age 67.0, 18 authors, study period 1 January, 2022 - 28 February, 2022.
Abstract: medRxiv preprint doi: https://doi.org/10.1101/2022.12.05.22283134; this version posted December 6, 2022. The copyright holder for this preprint
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Effectiveness of COVID-19 treatment with nirmatrelvir-ritonavir or molnupiravir among
U.S. Veterans: target trial emulation studies with one-month and six-month outcomes
Kristina L. Bajema, MD, MSc1,2; Kristin Berry, PhD3; Elani Streja, PhD4; Nallakkandi Rajeevan,
PhD4,5; Yuli Li, MS4; Lei Yan, PhD4,6; Francesca Cunningham, PharmD7; Denise M. Hynes,
MPH, PhD, RN8,9; Mazhgan Rowneki, MPH8; Amy Bohnert, PhD, MHS10,11; Edward J. Boyko,
MD, MPH12; Theodore J. Iwashyna, MD, PhD10,13; Matthew L. Maciejewski, PhD14,15,16; Thomas
F. Osborne17,18; Elizabeth M. Viglianti MD, MPH, MSc10,19; Mihaela Aslan, PhD4,20; Grant D.
Huang, MPH, PhD21; George N. Ioannou, BMBCh, MS3,22
1. Veterans Affairs Portland Health Care System, Portland, OR
2. Division of Infectious Diseases, Department of Medicine, Oregon Health and Sciences
University, Portland, OR
3. Research and Development, Veterans Affairs Puget Sound Health Care System,
4. Veterans Affairs Cooperative Studies Program Clinical Epidemiology Research Center
(CSP-CERC), Veterans Affairs Connecticut Healthcare System, West Haven, CT
5. Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT
6. Department of Biostatistics, Yale School of Public Health, New Haven, CT
7. Veterans Affairs Center for Medication Safety - Pharmacy Benefit Management (PBM)
Services, Hines, IL
8. Center of Innovation to Improve Veteran Involvement in Care (CIVIC), VA Portland
Healthcare System, Portland, OR
9. Health Management and Policy, School of Social and Behavioral Health Sciences,
College of Public Health and Human Sciences; Health Data and Informatics Program,
Center for Quantitative Life Sciences, Oregon State University, Corvallis, OR
10. Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann
11. Department of Anesthesiology, University of Michigan, Ann Arbor, MI
12. Seattle Epidemiologic Research and Information Center, Veterans Affairs Puget Sound
Health Care System, Seattle, WA
13. Schools of Medicine and Public Health, Johns Hopkins, Baltimore, MD
14. Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA
Medical Center, Durham, NC
15. Department of Population Health Sciences, Duke University School of Medicine,
16. Duke-Margolis Center for Health Policy, Duke University, Durham, NC
17. Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
18. Department of Radiology, Stanford University School of Medicine, Stanford, CA
19. Department of Internal Medicine, University of Michigan, Ann Arbor, MI
20. Department of Medicine, Yale School of Medicine, New Haven, CT
21. Office of Research and Development, Veterans Health Administration, Washington, DC
22. Divisions of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and
University of Washington, Seattle, WA
Primary Funding Source: U.S. Department of Veterans Affairs
NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.
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