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All Studies   All Outcomes       

Molnupiravir and nirmatrelvir-ritonavir reduce mortality risk during post-acute COVID-19 phase

Wan et al., Journal of Infection, doi:10.1016/j.jinf.2023.02.029
Feb 2023  
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Mortality 28% Improvement Relative Risk Hospitalization 24% Progression 18% Paxlovid for COVID-19  Wan et al.  LATE TREATMENT Is late treatment with paxlovid beneficial for COVID-19? Retrospective 23,887 patients in China (February - September 2022) Lower mortality (p<0.0001) and hospitalization (p<0.0001) c19early.org Wan et al., J. Infection, February 2023 Favorspaxlovid Favorscontrol 0 0.5 1 1.5 2+
Retrospective 30,040 hospitalized patients in Hong Kong, showing lower mortality with paxlovid treatment. Patients with contraindications to paxlovid were not excluded.
Resistance. Variants may be resistant to paxlovid1-3. Use may promote the emergence of variants that weaken host immunity and potentially contribute to long COVID4.
Confounding by contraindication. Hoertel et al. find that over 50% of patients that died had a contraindication for the use of Paxlovid5. Retrospective studies that do not exclude contraindicated patients may significantly overestimate efficacy.
Black box warning. The FDA notes that "severe, life-threatening, and/or fatal adverse reactions due to drug interactions have been reported in patients treated with paxlovid"6.
AKI. Kamo et al. show significantly increased risk of acute kidney injury.
Study covers molnupiravir and paxlovid.
risk of death, 28.0% lower, HR 0.72, p < 0.001, treatment 541 of 6,604 (8.2%), control 2,541 of 17,283 (14.7%), adjusted per study, multivariable, Cox proportional hazards.
risk of hospitalization, 24.0% lower, HR 0.76, p < 0.001, treatment 1,772 of 6,604 (26.8%), control 2,541 of 17,283 (14.7%), adjusted per study, multivariable, Cox proportional hazards.
risk of progression, 18.0% lower, HR 0.82, p < 0.001, treatment 1,816 of 6,604 (27.5%), control 2,541 of 17,283 (14.7%), adjusted per study, A&E admission, multivariable, Cox proportional hazards.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Wan et al., 22 Feb 2023, retrospective, China, peer-reviewed, 13 authors, study period 26 February, 2022 - 30 September, 2022. Contact: ewchan@hku.hk, wongick@hku.hk.
This PaperPaxlovidAll
Molnupiravir and nirmatrelvir-ritonavir reduce mortality risk during post-acute COVID-19 phase
Eric Yuk Fai Wan, MPH Boyuan Wang, BSc Sukriti Mathur, Cheyenne I Ying Chan, Vincent Ka Chun Yan, Francisco Tsz Tsun Lai, Celine Sze Ling Chui, PhD Xue Li, Carlos King Ho Wong, Chak Philip Hei Li, Chak Sing Lau, Prof Ian Chi Kei Wong, Dr Esther Wai Yin Chan
Journal of Infection, doi:10.1016/j.jinf.2023.02.029
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Ethics approval This study was approved by the Central Institutional Review Board of the Hospital Authority of Hong Kong (CIRB-2021-005-4) and the DH Ethics Committee (LM171/2021). Data sharing Data will not be made available to others because the data custodians have not given permission. Sources of funding
References
Agarwal, Rochwerg, Lamontagne, Siemieniuk, Agoritsas et al., A living WHO guideline on drugs for covid-19, BMJ
Evans, Qi, Adebayo, Underwood, Coulson et al., among higher-risk patients with COVID-19 in Wales: a retrospective cohort study
Ledford, Long-COVID treatments: why the world is still waiting, Nature
Wan, Chui, Lai, Chan, Li et al., Bell's palsy following vaccination with mRNA (BNT162b2) and inactivated (CoronaVac) SARS-CoV-2 vaccines: a case series and nested casecontrol study, The Lancet Infectious Diseases
Wan, Mok, Yan, Wang, Zhang et al., Vaccine effectiveness of BNT162b2 and CoronaVac against SARS-CoV-2 Omicron BA. 2 infection, hospitalisation, severe complications, cardiovascular disease and mortality in patients with diabetes mellitus: A case control study, Journal of Infection
Wan, Mok, Yan, Wang, Zhang et al., Vaccine effectiveness of BNT162b2 and CoronaVac against SARS-CoV-2 Omicron BA.2 infection, hospitalisation, severe complications, cardiovascular disease and mortality in patients with diabetes mellitus: A case control study, Journal of Infection
Wan, Wang, Chui, Mok, Xu et al., Safety of an inactivated, wholevirion COVID-19 vaccine (CoronaVac) in people aged 60 years or older in Hong Kong: a modified selfcontrolled case series, The Lancet Healthy Longevity
Wong, Au, Lau, Lau, Cowling et al., Real-world effectiveness of molnupiravir and nirmatrelvir plus ritonavir against mortality, hospitalisation, and in-hospital outcomes among community-dwelling, ambulatory patients with confirmed SARS-CoV-2 infection during the omicron wave in Hong Kong: a, Beta-blockers
Yan, Wan, Ye, Mok, Lai et al., Effectiveness of BNT162b2 and CoronaVac vaccinations against mortality and severe complications after SARS-CoV-2 Omicron BA. 2 infection: a case-control study, Emerging Microbes & Infections
Yip, Lui, Lai, Wong, Tse et al., Impact of the Use of Oral Antiviral Agents on the Risk of Hospitalization in Community Coronavirus Disease, Clinical Infectious Diseases
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Late treatment
is less effective
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