Remdesivir and molnupiravir had comparable efficacy in lung transplant recipients with mild-to-moderate COVID-19: a single center experience

Razia et al., Frontiers in Transplantation, doi:10.3389/frtra.2024.1408289, Jul 2024
Mortality -272% improvement lower risk ← → higher risk Ventilation -86% ICU admission -86% Hospitalization 28% Molnupiravir  Razia et al.  EARLY TREATMENT Is early treatment with molnupiravir beneficial for COVID-19? Retrospective 83 patients in Italy (March 2020 - August 2022) Higher mortality (p=0.28) and lower hospitalization (p=0.58), not sig. c19early.org Razia et al., Frontiers in Transplanta.., Jul 2024 0 0.5 1 1.5 2+ RR
Retrospective 113 lung transplant recipients with mild-to-moderate COVID-19 showing higher mortality with remdesivir and molnupiravir in unadjusted analysis, with statistical significance for remdesivir. mAb PrEP and treatment and the dominant variant favored molnupiravir compared with the control group, however they favored the control group compared with remdesivir.
Potential risks of molnupiravir include the creation of dangerous variants, and mutagenicity, carcinogenicity, teratogenicity, and embryotoxicity1-15. Multiple analyses have identified variants potentially created by molnupiravir16-20.
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Study covers molnupiravir and remdesivir.
risk of death, 272.4% higher, RR 3.72, p = 0.28, treatment 2 of 29 (6.9%), control 1 of 54 (1.9%).
risk of mechanical ventilation, 86.2% higher, RR 1.86, p = 1.00, treatment 1 of 29 (3.4%), control 1 of 54 (1.9%).
risk of ICU admission, 86.2% higher, RR 1.86, p = 0.61, treatment 2 of 29 (6.9%), control 2 of 54 (3.7%).
risk of hospitalization, 28.4% lower, RR 0.72, p = 0.58, treatment 5 of 29 (17.2%), control 13 of 54 (24.1%), NNT 15.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Razia et al., 4 Jul 2024, retrospective, Italy, peer-reviewed, 6 authors, study period March 2020 - August 2022. Contact: sofya.tokman@dignityhealth.org.
$0 $500 $1,000+ Efficacy vs. cost for COVID-19 treatment protocols c19early.org November 2025 Italy United Kingdom Russia USA Sudan Angola Colombia Kenya Mozambique Vietnam Peru Philippines China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Bosnia-Herzegovina Ukraine Côte d'Ivoire Bulgaria Greece Slovakia Singapore Iceland New Zealand Czechia Mongolia Israel Trinidad and Tobago Hong Kong North Macedonia Belarus Qatar Panama Serbia CAR Italy favored high-profit treatments.The average efficacy of treatments was very low.High-cost protocols reduce early treatment, andforgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
$0 $500 $1,000+ Efficacy vs. cost for COVID-19treatment protocols worldwide c19early.org November 2025 Italy United Kingdom Russia USA Sudan Angola Colombia Kenya Mozambique Vietnam Peru Philippines China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Bosnia-Herzegovina Ukraine Côte d'Ivoire Eritrea Bulgaria Greece Slovakia Singapore New Zealand Malawi Czechia Mongolia Israel Trinidad and Tobago North Macedonia Belarus Qatar Panama Serbia Syria Italy favored high-profit treatments.The average efficacy was very low.High-cost protocols reduce early treatment,and forgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
Remdesivir and molnupiravir had comparable efficacy in lung transplant recipients with mild-to-moderate COVID-19: a single center experience
Deepika Razia, Devika Sindu, Lauren Cherrier, Katherine Grief, Rajat Walia, Sofya Tokman
Frontiers in Transplantation, doi:10.3389/frtra.2024.1408289
Introduction: Remdesivir (REM) and molnupiravir (MOL) are commonly used to treat lung transplant recipients (LTRs) with COVID-19; however, the clinical efficacy of these medications is yet to be compared. In this retrospective cohort study, we compared the clinical outcomes between LTRs with mild-tomoderate COVID-19 treated with REM and those treated with MOL. Methods and Results: Between March 2020 and August 2022, 195 LTRs developed COVID-19 at our center. After excluding 82 who presented with severe disease requiring hospitalization, the remaining 113 were included in the analysis: 54 did not receive antiviral treatment, 30 were treated with REM, and 29 were treated with MOL. Adjusted multivariable logistic regression analysis showed similar rates of hospitalization (adjusted odds ratio (aOR) 1.169, [95% confidence interval (95% CI) 0.105-12.997, p = 0.899], ICU admission (aOR 0.822, 95% CI 0.042-16.220, p = 0.898), mechanical ventilation (aOR 0.903, 95% CI 0.015-55.124, p = 0.961), and COVID-19related mortality (aOR 0.822, 95% CI 0.042-16.220, p = 0.898) between LTRs treated with REM and those treated with MOL for mild-to-moderate COVID-19, irrespective of SARS-CoV-2 strain. Conclusion: MOL may be a suitable alternative to REM to treat LTRs with mildto-moderate COVID-19, and the choice of antiviral therapy can be driven by practical considerations such as route of administration and drug availability.
Ethics statement The studies involving humans were approved by The Institutional Review Board of St. Joseph's Hospital and Medical Center. The studies were conducted in accordance with the local legislation and institutional requirements. The Ethics Committee/institutional review board waived the requirement of written informed consent for participation from the participants or the participants' legal guardians/next of kin because the study was a retrospective data analysis study with no identifiable patient information. Author contributions Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Publisher's note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
Bhimraj, Morgan, Shumaker, Baden, Cheng et al., Infectious Diseases Society of America Guidelines on the treatment and management of patients with coronavirus disease 2019 (COVID-19), Clin Infect Dis, doi:10.1093/cid/ciac724
Dauriat, Beaumont, Nguyen, Picard, Penhouet et al., Efficacy of three COVID-19 vaccine doses in lung transplant recipients: a multicentre cohort study, Eur Respir J, doi:10.1183/13993003.00502-2022
Gottlieb, Vaca, Paredes, Mera, Webb et al., Early remdesivir to prevent progression to severe COVID-19 in outpatients, N Engl J Med, doi:10.1056/NEJMoa2116846
Hallett, Greenberg, Boyarsky, Shah, Ou et al., SARS-CoV-2 messenger RNA vaccine antibody response and reactogenicity in heart and lung transplant recipients, J Heart Lung Transplant, doi:10.1016/j.healun.2021.07.026
Havlin, Svorcova, Dvorackova, Lastovicka, Lischke et al., Immunogenicity of BNT162b2 mRNA COVID-19 vaccine and SARS-CoV-2 infection in lung transplant recipients, J Heart Lung Transplant, doi:10.1016/j.healun.2021.05.004
Lo, Jordan, Arvey, Sudhamsu, Shrivastava-Ranjan et al., GS-5734 and its parent nucleoside analog inhibit filo-, pneumo-, and paramyxoviruses, Sci Rep, doi:10.1038/srep43395
Narasimhan, Mahimainathan, Clark, Usmani, Cao et al., Serological response in lung transplant recipients after two doses of SARS-CoV-2 mRNA vaccines, Vaccines, doi:10.3390/vaccines9070708
Peled, Lavee, Sternik, Segev, Wieder-Finesod, BNT162b2 vaccination in heart transplant recipients: clinical experience and antibody response, J Heart Lung Transplant, doi:10.1016/j.healun.2021.04.003
Razia, None
Sheahan, Sims, Graham, Menachery, Gralinski et al., Broad-spectrum antiviral GS-5734 inhibits both epidemic and zoonotic coronaviruses, Sci Transl Med, doi:10.1126/scitranslmed.aal3653
Sindu, Razia, Bay, Padiyar, Grief et al., Evolving impact of the COVID-19 pandemic on lung transplant recipients: a single-center experience, J Heart Lung Transplant, doi:10.1016/j.healun.2023.10.010
Warren, Jordan, Lo, Ray, Mackman et al., Therapeutic efficacy of the small molecule GS-5734 against Ebola virus in rhesus monkeys, Nature, doi:10.1038/nature17180
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Adjusted multivariable logistic regression analysis showed similar rates of hospitalization (adjusted odds ratio (aOR) 1.169, [95% confidence interval (95% CI) 0.105–12.997, <jats:italic>p</jats:italic> = 0.899], ICU admission (aOR 0.822, 95% CI 0.042–16.220, <jats:italic>p</jats:italic> = 0.898), mechanical ventilation (aOR 0.903, 95% CI 0.015–55.124, <jats:italic>p</jats:italic> = 0.961), and COVID-19-related mortality (aOR 0.822, 95% CI 0.042–16.220, <jats:italic>p</jats:italic> = 0.898) between LTRs treated with REM and those treated with MOL for mild-to-moderate COVID-19, irrespective of SARS-CoV-2 strain.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>MOL may be a suitable alternative to REM to treat LTRs with mild-to-moderate COVID-19, and the choice of antiviral therapy can be driven by practical considerations such as route of administration and drug availability.</jats:p></jats:sec>", "alternative-id": [ "10.3389/frtra.2024.1408289" ], "author": [ { "affiliation": [], "family": "Razia", "given": "Deepika", "sequence": "first" }, { "affiliation": [], "family": "Sindu", "given": "Devika", "sequence": "additional" }, { "affiliation": [], "family": "Cherrier", "given": "Lauren", "sequence": "additional" }, { "affiliation": [], "family": "Grief", "given": "Katherine", "sequence": "additional" }, { "affiliation": [], "family": "Walia", "given": "Rajat", "sequence": "additional" }, { "affiliation": [], "family": "Tokman", "given": "Sofya", "sequence": "additional" } ], "container-title": "Frontiers in Transplantation", "container-title-short": "Front. 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