Oral antivirals for COVID-19 among patients with cancer
Purpose: Immunocompromised individuals, such as those diagnosed with cancer, are at a signi cantly higher risk for severe illness and mortality when infected with SARS-CoV-2 (COVID-19) than the general population. Two oral antiviral treatments are approved for COVID-19: Paxlovid® (nirmatrelvir/ritonavir) and Lagevrio® (molnupiravir). There is a paucity of data regarding the bene t from these antivirals among immunocompromised patients with cancer, and recent studies have questioned their e cacy among vaccinated patients, even those with risk factors for severe COVID-19. Methods: We evaluated the e cacy and safety of nirmatrelvir/ritonavir and molnupiravir in preventing severe illness and death using our database of 457 patients with cancer and COVID-19 from Brown University-a liated hospitals. 67 patients received nirmatrelvir/ritonavir or molnupiravir and were compared to 56 concurrent controls who received no antiviral treatment despite being eligible to receive it. Results: Administration of nirmatrelvir/ritonavir or molnupiravir was associated with improved survival and lower 90-day all-cause and COVID-19-attributed mortality (p<0.05) and with lower peak O2 requirements (ordinal odds ratio [OR] 1.52, 95% con dence interval [CI] 0.92-2.56). Conclusion: Acknowledging the small size of our sample as a limitation, we concluded that early antiviral treatment might be bene cial to immunocompromised individuals, particularly those with cancer, when infected with SARS-CoV-2. Larger-scale, well-strati ed studies are needed in this patient population.
Declarations Competing Interests DF has received research support from Viracor, Astellas and Merck, and consultant fee from Viracor. All other authors have nothing to disclose.
Ethics approval: The study was approved by the Lifespan Institutional Review Board (IRB). The study was conducted in accordance with the declaration of Helsinki.
Consent to publish: All authors agreed to the publication of the manuscript.
Consent to participate: The study was approved by the Lifespan Institutional Review Board (IRB) with a waiver of informed consent given its retrospective design and de-identi ed data.
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